An observational study of physiotherapists’ use of cognitive-behavioural principles in the management of patients with back pain and neck pain

ObjectivesThis study investigated the extent to which physiotherapists collaborating in a randomised trial comparing the McKenzie approach with a Solution Finding Approach (SFA) for back pain or neck pain involved patients in the consultation, and empowered patients to develop self-management strategies. The aims were to develop a tool for this purpose and to identify any observed differences between the consultations in these two approaches.DesignAn observational study, conducted within a randomised trial (McKABI trial).SettingPatients referred to seven National Health Service physiotherapy departments in West and East Yorkshire.ParticipantsThe observational study collected data from 10 of the 28 physiotherapists participating in the McKABI trial.Main outcome measuresThe involvement and empowerment scales of the Involvement and Empowerment of Patients in Physiotherapy Assessment Rating Tool (IMPART).ResultsAlthough not widely used, physiotherapists employed significantly more patient involvement and empowerment strategies with the SFA compared with the McKenzie approach. The median (interquartile range)/total possible scores were: SFA 19 (18), McKenzie 10 (4.5)/60 for involvement; and SFA 27 (8), McKenzie 11 (10)/64 for empowerment.ConclusionsMost physiotherapists were able to switch between the two approaches without significant overlap in techniques. Psychosocial questioning and goal-setting were under-utilised by most physiotherapists. Implementing the SFA protocol appeared to be more difficult than the McKenzie approach, possibly because the SFA was less reliant on a structured format. Physiotherapists may have required more training to enable them to deliver the SFA effectively. The IMPART was a reliable measure of physiotherapists’ involvement and empowerment strategies.