Ballengee Lindsay A, Covington J Kyle, George Steven Z
Department of Orthopaedic Surgery, Duke University School of Medicine and Durham VA Health Care System Center of Innovation to Accelerate Discovery and Practice Transformation, 411 W Chapel Hill Street Ste 600, Durham, NC, 27701, USA.
Department of Orthopaedic Surgery, Division of Physical Therapy, Duke University School of Medicine, 311 Trent Drive, Durham, NC, 27710, USA.
BMC Med Educ. 2020 Oct 23;20(1):382. doi: 10.1186/s12909-020-02272-5.
There is an increasing need for physical therapists to address psychosocial aspects of musculoskeletal pain. Psychologically informed practice is one way to deliver this type of care through the integration of biopsychosocial interventions into patient management. An important component of psychologically informed practice is patient centered communication. However, there is little research on how to effectively implement patient centered communication into pre-licensure training for physical therapists.
Thirty Doctor of Physical Therapy (DPT) students took part in an educational intervention that consisted of one 4-h didactic teaching session and three 1-h experiential learning sessions. Prior to the first session, students performed an examination of a standardized patient with chronic low back pain and were assessed on psychologically informed physical therapy (PIPT) adherent behaviors via a rating scale. Students also completed the Pain Attitudes and Beliefs Scale (PABS-PT). After the last experiential session, students evaluated another standardized patient and were reassessed on PIPT adherent behaviors. Students retook the PABS-PT and qualitative data was also collected.
After the educational intervention, students had positive changes in their pain attitudes and belief scores indicating a stronger orientation toward a psychosocial approach to patient care (p < 0.05). Additionally, after the intervention, students showed improvements in their adherence to using PIPT behaviors in their simulated patient interactions (p < 0.05). Qualitatively, students reported a high acceptability of the educational intervention with common themes indicating improved confidence with treating and communicating with complex patients.
Students had attitudes and beliefs shift towards a more psychosocial orientation and demonstrated improved PIPT behaviors in simulated patient interactions after a brief educational intervention. Future research should investigate best practices for implementation of psychologically informed physical therapy for licensed clinicians.
物理治疗师越来越需要关注肌肉骨骼疼痛的心理社会方面。基于心理的实践是通过将生物心理社会干预整合到患者管理中来提供此类护理的一种方式。基于心理的实践的一个重要组成部分是以患者为中心的沟通。然而，关于如何有效地将以患者为中心的沟通纳入物理治疗师的执照前培训的研究很少。
30名物理治疗博士（DPT）学生参加了一项教育干预，该干预包括一次4小时的理论教学课程和三次1小时的体验式学习课程。在第一节课之前，学生们对一名患有慢性腰痛的标准化患者进行了检查，并通过评分量表对基于心理的物理治疗（PIPT）依从行为进行了评估。学生们还完成了疼痛态度和信念量表（PABS-PT）。在最后一次体验课程之后，学生们对另一名标准化患者进行了评估，并对PIPT依从行为进行了重新评估。学生们重新进行了PABS-PT测试，并收集了定性数据。
经过教育干预后，学生们的疼痛态度和信念得分有了积极变化，表明他们更倾向于采用心理社会方法来进行患者护理（p < 0.05）。此外，干预后，学生们在模拟患者互动中使用PIPT行为的依从性有所提高（p < 0.05）。从定性方面来看，学生们报告说该教育干预具有很高的可接受性，常见主题表明他们在治疗复杂患者和与他们沟通方面的信心有所提高。
经过简短的教育干预后，学生们的态度和信念转向了更具心理社会导向，并在模拟患者互动中表现出改善的PIPT行为。未来的研究应该调查为执业临床医生实施基于心理的物理治疗的最佳实践。
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