Treatment guidelines for low back pain (LBP) advocate the use of cognitive behavioural approaches, typically delivered by physiotherapists. This thesis explores the role of physiotherapist competence in the delivery of these approaches. A systematic review of the literature found an absence of tools appropriate for the assessment of competence in delivering cognitive behavioural (CB) approaches in LBP. A consensus study was undertaken with experts and a new competency tool was developed with good psychometric properties. This competency tool was then used to explore the relationship between competency and clinical outcome in a cohort of LBP patients. New insights into the role of experience on competence and patient outcome were found. Competence in delivering a CB intervention varied within the cohort. Specific previous experience of delivering similar interventions predicted competence score but not patient outcome. Years since qualification did not predict competence but negatively predicted patient outcome. Overall competence was not found to predict patient outcome in delivering a structured, manualised, cognitive behavioural approach for LBP and possible reasons for this finding are discussed. Competence was further explored through a qualitative interview study which found interesting patterns in beliefs and behaviours of the physiotherapists. The most competent physiotherapists consistently discussed aspects of reflective learning on their practice. Physiotherapists reported most difficulty with switching from a didactic stance to one of a questioning approach. Overall physiotherapists valued the structure of the manualised CB approach they delivered in the study. Physiotherapists reported the CB approach was most difficult to apply to the patient group that the skills are advocated for, i.e. those with poor coping skills and high psychosocial risk factors. The thesis concludes with suggestions on how training in a CB approach may be enhanced for physiotherapists working with a LBP patient population.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:618932 |
| Date | January 2013 |
| Creators | Hansen, Zara |
| Publisher | University of Warwick |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Source | http://wrap.warwick.ac.uk/62983/ |
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