Becoming confidently competent: a qualitative investigation of training in cognitive functional therapy for persistent low back pain

• Published in: Physiotherapy theory and practice Vol. 40; no. 4; pp. 804 - 816
• Main Authors: Simpson, Phoebe, Holopainen, Riikka, Schütze, Robert, O’Sullivan, Peter, Smith, Anne, Kent, Peter
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis Ltd 02.04.2024
• Subjects: Barriers; Behavior change; Biopsychosocial aspects; Change agents; Competency based learning; Culture; Experiential learning; Graduate studies; Intervention; Low back pain; Musculoskeletal pain; Physical therapists; Physical therapy; Physiotherapy; Trainers; Biopsychosocial; training; physiotherapist; competency; qualitative
• ISSN: 0959-3985; 1532-5040; 1532-5040
• DOI: 10.1080/09593985.2022.2151333

Physiotherapists trained to deliver biopsychosocial interventions for complex musculoskeletal pain problems often report difficulties in confidence and competency at the end of training. Cognitive Functional Therapy (CFT) is an individualized biopsychosocial intervention and understanding the facilitators and barriers to training in CFT will help inform future training programs. This study aimed to explore physiotherapists' and trainers' perceptions of the process of developing competency in CFT. A cross-sectional qualitative design using interviews of 18 physiotherapists and two trainers investigated training in CFT for persistent LBP via reflexive thematic analysis. Physiotherapists reported undergoing a complex behavior change process during training. Four themes emerged: 1) Pre-training factors; 2) Behavior change process; 3) Physiotherapy culture and context; and 4) Confident competence and beyond. Key components included graduated practice exposure linked to experiential learning with feedback and clear competency guidelines. Pre-training and contextual factors were facilitators or barriers depending on the individual. Physiotherapists supported ongoing learning, even after competency was achieved. This study provides insight into the processes of change during progress toward competency in CFT. It highlights facilitators and barriers to competency including physiotherapy culture and the clinical environment. The study also describes important educational components, including experiential learning and clinical integration, which may be used to inform future post-graduate training.