The role of chartered physiotherapists in the psychological rehabilitation from sport injuries: Recent research findings and suggestions for further research Monna Arvinen-Barrow

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The role of chartered physiotherapists in the
psychological rehabilitation from sport
injuriesRecent research findings and
suggestions for further research Monna
Arvinen-Barrow
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Outline

• Introduction rationale
• An overview of the research
• Chosen methodologies
• Key findings
• Practical implications of the findings to sport
  medicine professionals
• Application of the findings to physical activity
  and exercise settings
• Suggestions for further research

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Introduction

• Psychological issues can have a significant
  impact on athletes recovery from sport-related
  injuries and adherence to the treatment processes
  (e.g., Brewer et al., 2000 Ievleva and Orlick,
  1991)
• Medical professionals (e.g., physiotherapists) in
  regular contact with the athlete during treatment
  are in an ideal position to inform, educate, and
  assist with both psychological and physical
  process of injury (e.g., Gordon, Potter, Ford,
  1998 Pearson Jones, 1992)
• However during their professional training, they
  receive very little or no training in terms of
  how psychological techniques can facilitate
  recovery processes and how to use these
  techniques in their work with injured athletes
  (Kolt Andersen, 2004 Taylor Taylor, 1997)

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Introduction rationale
To provide answers to some of the
under-researched issues in the field, onto which
future training of chartered physiotherapists and
subsequently testing the usefulness of such
training could be based upon

• Apart from the research published from this PhD,
  existing research in the UK exploring
  physiotherapists role in psychological
  rehabilitation was sparse
• Hemmings Povey (2002)
• McKenna, Delaney, Phillips (2002)
• Jevon Johnston (2003)
• Heaney (2006)
• Therefore the purpose of this research was to
  establish the role of the UK chartered
  physiotherapists in psychological rehabilitation
  from sports injuries

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An overview of the research Study 1

• A quantitative questionnaire survey (PSPQ)
  replicating preliminary research by Hemmings
  Povey, (2002)
• PARTICIPANTS
• Chartered physiotherapists (not NHS)
• (N 361, of which 68.7 females, and 31.3
  males)
• Physiotherapy experience M(SD) 19.04 (9.89)
• Sport physiotherapy experience M(SD) 12.98
  (8.52)
• In total, 56 of the respondents (n 202) had a
  postgraduate
• qualification

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An overview of the research Study 2

• Development and testing a preliminary survey
  measure to
• investigate physiotherapists preferred methods of
  training delivery
• for further training in sport psychology
• PARTICIPANTS
• Chartered physiotherapists (not NHS)
• (N 22, of which n 14 females, and n 8
  males)
• Physiotherapy experience M(SD) 14.53 (7.3),
• Sport physiotherapy experience M(SD) 9.81 (6.16)
  
• In total, 59.1 of the respondents (n 13) had a
  postgraduate
• qualification

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An overview of the research Study 3

• Using semi-structured interviews and IPA (Smith,
  1996), study 3
• aimed to explore chartered physiotherapists
  personal experiences in
• dealing with psychological issues during sport
  injury rehabilitation
• physiotherapy
• PARTICIPANTS
• Chartered physiotherapists (not NHS)
• (N 7, of which n 4 females, and n 3 males)

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An overview of the research Study 4

• Using semi-structured interviews and IPA (Smith,
  1996), study 4
• aimed to explore injured athletes experiences of,
  and their views on
• psychological aspects of rehabilitation
  physiotherapy
• PARTICIPANTS
• Previously injured (return back to sport within
  the last few weeks)
• professional football and rugby players
• (N 10)
• Restriction on sport participation M 19 weeks,
• ranging from 6 weeks to 10 months

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Key Findings Quantitative surveys

• Physiotherapists in the UK believe all athletes
  are psychologically affected by their injuries
• Physiotherapists also reported using a range of
  psychological intervention techniques/strategies
  as part of the rehabilitation, and expressed the
  need for further training in such skills as
  important
• The results from the preliminary survey revealed
  that physiotherapists appeared to prefer intense
  training days/weekends in the form of traditional
  going-to training methods (e.g., workshops,
  seminars) over more contemporary distance
  learning methods

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Key Findings Qualitative findings

• The physiotherapists spoke openly about their
  lack of formal training in sport psychology
• Physiotherapists knowledge and understanding of
  the intervention techniques varied
• Emphasis on the importance of gut-feeling and
  experiential learning
• Knowing your role

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Key Findings Injured athletes perspective

• Frustration and feelings of self-doubt as the
  main emotional responses to injuries
• Injuries seen as part and parcel
• Highlighted the importance of just getting on
  with the rehabilitation
• The importance of social support (girlfriends,
  family, friends, team mates, other injured
  athletes, and the physiotherapists)
• Physiotherapist as primary treatment provider
• Trust in their ability, expertise, and ability to
  treat the injury
• Clear expectations of the physiotherapy (physical
  parameters)
• Communication highly focused on pain
• Subtlety of the psychological support

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Practical implications for sports medicine
professionals

• Further training in goal setting, social support,
  imagery, relaxation techniques and self-talk is
  useful and should be part of continued
  professional development
• Facilitating greater levels of communication
  during rehabilitation can assist physiotherapists
  in understanding individual athlete better and
  therefore enable greater levels of care
• Acknowledging personal role in the process
  physiotherapists are in an ideal position to
  inform athletes and to facilitate and integrate
  psychological interventions into their work
• Any implementation of psychological intervention
  should be done in a way that athletes perceive it
  to be a natural part of the rehabilitation process

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Application of the findings to PA and exercise
settings
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Suggestions for further research

• Understanding of the emotional implications of
  injuries in PA and exercise
• Investigating the role of psychological aspects
  of PA/exercise injuries in relation to barriers
  to exercise/relapse in exercise behaviour
• Understanding the role of physiotherapists
  working within NHS or PCT with regards to
  treating psychological aspects of PA or exercise
  injuries
• Subsequently assessing the need for further
  training in psychology for chartered
  physiotherapist
• Exploration of patient-therapist expectations of
  physiotherapy (within and outside the NHS/PCT)