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“A light bulb moment!” Physiotherapists’ experiences of delivering Physiotherapy informed by Acceptance and Commitment Therapy (PACT)
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The 4th European Congress of the ER-WCPT / Physiotherapy 102S (2016) eS67–eS282
4. Which treatment modalities were used; 5. How many times on average a patient would be seen; 6. The average time in weeks between first appointment and discharge; 7. The average total number of hours a patient would receive. Results: A total of 13 tweets were sent between the 10th and 15th of November 2015 of which 783 engagements occurred. There were 62 responses from 25 different counties across the UK from physiotherapists working in hospital outpatient or community areas. The number of years qualified ranged from under one year to over ten years, with 42% working more than 10 years. Mean waiting time was 6.2 weeks (range 1 to 18 weeks). The mean number of times a patient was seen was 3.6 (1 to 8 times), and the mean total number of hours treatment was given was 2.5 (1 to 5 hours). Mean overall treatment time was 8.0 weeks (0 to 16 weeks). 63% of respondents used mobilisation of hip as a type of manual therapy, 27% mobilisation of other joints, 7% manipulation and 24% soft tissue. All respondents used strengthening exercises, 73% stretching exercises, 50% cardiovascular exercises, 73% balance exercises and 26% co-ordination exercises. Only 39% of respondents answered that they included strengthening and cardiovascular exercises, along with an education leaflet. None performed ultrasound, 2% carried out pulsed short wave diathermy, and 21% heat/ice therapy. 44% gave out an education leaflet developed locally, 63% gave out a standard education leaflet. None of the respondents mentioned advice on weight loss as part of their treatment. Discussion and conclusions: The survey confirms that waiting times, number of sessions and treatments in the management of hip osteoarthritis vary widely across the UK; and only 39% of respondents use strengthening and cardiovascular exercises and provide an education leaflet, as recommended by NICE. Impact and implications: Further research is needed to explore how NICE guidelines can be effectively disseminated and utilised within physiotherapy clinical practice. Funding acknowledgement: This work was unfunded. http://dx.doi.org/10.1016/j.physio.2016.10.284
POS228 “A light bulb moment!” Physiotherapists’ experiences of delivering Physiotherapy informed by Acceptance and Commitment Therapy (PACT) D.J. Critchley 1,∗ , M. Galea Holmes 2 , V. Wileman 2 , L. McCracken 2 , E. Godfrey 1,2 1 King’s
College London, Department of Physiotherapy/Health and Social Care Research, London, United Kingdom 2 King’s College London, Department of Psychology, Institute of Psychology, Psychiatry and Neuroscience, London, United Kingdom Relevance: Persistent non-specific low back pain is huge burden for individuals, health-care systems, and societies world-wide. Effective management is a challenge for patients and clinicians and clinical outcomes are often modest. Acceptance and Commitment Therapy (ACT) is a theory-based form of CBT with promising outcomes in persistent pain. We have developed a Physiotherapy intervention informed by Acceptance and Commitment Therapy (PACT) which augments physiotherapy with theory-based psychological methods, aiming to improve clinical outcomes. Physiotherapists were trained in PACT before delivery in a clinical trial www.controlled-trials.com/ISRCTN95392287. Purpose: This longitudinal qualitative study explored the feasibility and acceptability of training and treatment amongst physiotherapists delivering PACT. Methods/analysis: Individual semi-structured interviews were conducted by independent researchers. Physiotherapists were interviewed three times over 18 months: after training, six months later, and at the end of treatment delivery. Interviews were audio recorded, transcribed verbatim and analysed using the framework approach to generate key themes. Respondent validity and independent coding by another researcher were conducted to check the validity of emergent themes. Results: Eleven physiotherapists (Band 6 to 8; mean age 40 years, range 26 to 52; eight females) from three NHS hospital trusts in SE England were interviewed. Four themes emerged: (1) Barriers and facilitators to implementing training “I’m cool about (sticking to PACT) to be honest because you know what we are doing for back pain as a profession is rubbish.” “I think (PACT) fits with the role, not just my role, but any physio working in particularly the NHS environment, I think it fits very well.” (2) Value of supervision and support throughout the trial “you would have to shake up the whole physiotherapy community quite a bit I think in order to be on regular supervision for physiotherapists” “. . .we feel that we’ve
The 4th European Congress of the ER-WCPT / Physiotherapy 102S (2016) eS67–eS282
got someone to got to if we’re having a problem with something and they don’t make you feel like the question you’re asking is silly.” (3) Challenging personal and patient responses “learning about a completely different new type of physiotherapy but not having structure to a session was very scary for me”. “A lot of patients will come in . . . and they’ll hear it and they’ll just be like ‘right, fix me now”’ (4) Importance of context for translation into routine care. “. . .it’s good having more than half an hour. . .you have time to spend really working through what their beliefs are and what they find difficult. . .rather than having one eye watching the clock.” “(Private room is helpful because). . .talking about what things are difficult without feeling that other people can hear through their curtain.” Discussion and conclusions: Physiotherapists found PACT was acceptable and feasible, fitted with but expanded with their role and competencies, had no fundamental barriers to implementation, with caveats about changes necessary to current practice and facilities. Impact and implications: These findings suggest PACT could successfully broaden the scope of practice of physiotherapists treating persistent back pain and inform future research in this area. Funding acknowledgement: The PACT study was funded by NIHR RfPB. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health in England. http://dx.doi.org/10.1016/j.physio.2016.10.285 POS229 Physiotherapy students and practice-based educators’ experiences of using placement passports during their practice-based education S.-J. Ryan ∗ , J. Morris University of Brighton, Health Sciences, Eastbourne, United Kingdom Relevance: Health professional students all undertake practice education in a range of practice settings. These placements form a mandatory and integral part of their programme of study and are essential in order to prepare them for their future role as health professionals. One of the commonly used tools that is used to facilitate students as adult learners on placement is the negotiated learning agreement or learning contract (Cross et al., 2006). This facilitation tool provides a useful framework that promotes discussion between student and educator encouraging students to identify their learning needs, establish learning outcomes and to discuss evidence that will be used to assess the learning outcomes (Cross et al., 2006). However anecdotally and some research suggests that students particularly those on first placements find it chal-
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lenging to identify their learning needs and establish realistic learning goals. Purpose: The aim of this study is to explore physiotherapy students and practice based educators experiences of using placement passports before and during placement. Methods/analysis: The methodological approach employed will be phenomenological in nature as it acknowledges the individuals unique experience and how they have come to form their world view (Nicholls, 2009b). Sampling included final year students on a pre-registration Rehabilitation Science Masters and Bachelor of Science Physiotherapy at the University of Brighton (UoB) and practice based educators who were supporting students locally and were alumni of the UoB. Purposive sampling was chosen as it provided participants with meaningful insight in the phenomena of using the placement passport in identifying own learning needs to gain the most from their practice placement experience. A series of semi-structured interviews were carried out with final year students and practice based educators exploring this concept. The interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis (Braun & Clarke, 2006). Results: Preliminary findings indicate that students found that the passports allowed them to disclose previous experiences particularly struggles and areas for development that encouraged them to be more open during the negotiation of the learning contract. It was felt that it made the learning contract more individualised. Practice based educators discussed the usefulness of gaining insight into the student prior to the placement and giving them time to reflect on best ways of supporting to help the student achieve their best within the confines of service provision. Discussion and conclusions: The placement passport that has been designed to support students’ prior disclosure of learning needs including additional learning needs. Our aim was to facilitate disclosure across the whole cohort and to encourage students to identify their strengths and areas for development that help in the negotiation phase of learning agreements. Impact and implications: A range of learning and teaching approaches are used to enable students and practice educators to work together to ensure that students learning needs are met and patient safety and quality of care is given the highest priority (Cross et al., 2006). Funding acknowledgement: University of Brighton Clinical Research Centre for Health Sciences Staff Internal Research Grants. http://dx.doi.org/10.1016/j.physio.2016.10.286
The 4th European Congress of the ER-WCPT / Physiotherapy 102S (2016) eS67–eS282
4. Which treatment modalities were used; 5. How many times on average a patient would be seen; 6. The average time in weeks between first appointment and discharge; 7. The average total number of hours a patient would receive. Results: A total of 13 tweets were sent between the 10th and 15th of November 2015 of which 783 engagements occurred. There were 62 responses from 25 different counties across the UK from physiotherapists working in hospital outpatient or community areas. The number of years qualified ranged from under one year to over ten years, with 42% working more than 10 years. Mean waiting time was 6.2 weeks (range 1 to 18 weeks). The mean number of times a patient was seen was 3.6 (1 to 8 times), and the mean total number of hours treatment was given was 2.5 (1 to 5 hours). Mean overall treatment time was 8.0 weeks (0 to 16 weeks). 63% of respondents used mobilisation of hip as a type of manual therapy, 27% mobilisation of other joints, 7% manipulation and 24% soft tissue. All respondents used strengthening exercises, 73% stretching exercises, 50% cardiovascular exercises, 73% balance exercises and 26% co-ordination exercises. Only 39% of respondents answered that they included strengthening and cardiovascular exercises, along with an education leaflet. None performed ultrasound, 2% carried out pulsed short wave diathermy, and 21% heat/ice therapy. 44% gave out an education leaflet developed locally, 63% gave out a standard education leaflet. None of the respondents mentioned advice on weight loss as part of their treatment. Discussion and conclusions: The survey confirms that waiting times, number of sessions and treatments in the management of hip osteoarthritis vary widely across the UK; and only 39% of respondents use strengthening and cardiovascular exercises and provide an education leaflet, as recommended by NICE. Impact and implications: Further research is needed to explore how NICE guidelines can be effectively disseminated and utilised within physiotherapy clinical practice. Funding acknowledgement: This work was unfunded. http://dx.doi.org/10.1016/j.physio.2016.10.284
POS228 “A light bulb moment!” Physiotherapists’ experiences of delivering Physiotherapy informed by Acceptance and Commitment Therapy (PACT) D.J. Critchley 1,∗ , M. Galea Holmes 2 , V. Wileman 2 , L. McCracken 2 , E. Godfrey 1,2 1 King’s
College London, Department of Physiotherapy/Health and Social Care Research, London, United Kingdom 2 King’s College London, Department of Psychology, Institute of Psychology, Psychiatry and Neuroscience, London, United Kingdom Relevance: Persistent non-specific low back pain is huge burden for individuals, health-care systems, and societies world-wide. Effective management is a challenge for patients and clinicians and clinical outcomes are often modest. Acceptance and Commitment Therapy (ACT) is a theory-based form of CBT with promising outcomes in persistent pain. We have developed a Physiotherapy intervention informed by Acceptance and Commitment Therapy (PACT) which augments physiotherapy with theory-based psychological methods, aiming to improve clinical outcomes. Physiotherapists were trained in PACT before delivery in a clinical trial www.controlled-trials.com/ISRCTN95392287. Purpose: This longitudinal qualitative study explored the feasibility and acceptability of training and treatment amongst physiotherapists delivering PACT. Methods/analysis: Individual semi-structured interviews were conducted by independent researchers. Physiotherapists were interviewed three times over 18 months: after training, six months later, and at the end of treatment delivery. Interviews were audio recorded, transcribed verbatim and analysed using the framework approach to generate key themes. Respondent validity and independent coding by another researcher were conducted to check the validity of emergent themes. Results: Eleven physiotherapists (Band 6 to 8; mean age 40 years, range 26 to 52; eight females) from three NHS hospital trusts in SE England were interviewed. Four themes emerged: (1) Barriers and facilitators to implementing training “I’m cool about (sticking to PACT) to be honest because you know what we are doing for back pain as a profession is rubbish.” “I think (PACT) fits with the role, not just my role, but any physio working in particularly the NHS environment, I think it fits very well.” (2) Value of supervision and support throughout the trial “you would have to shake up the whole physiotherapy community quite a bit I think in order to be on regular supervision for physiotherapists” “. . .we feel that we’ve
The 4th European Congress of the ER-WCPT / Physiotherapy 102S (2016) eS67–eS282
got someone to got to if we’re having a problem with something and they don’t make you feel like the question you’re asking is silly.” (3) Challenging personal and patient responses “learning about a completely different new type of physiotherapy but not having structure to a session was very scary for me”. “A lot of patients will come in . . . and they’ll hear it and they’ll just be like ‘right, fix me now”’ (4) Importance of context for translation into routine care. “. . .it’s good having more than half an hour. . .you have time to spend really working through what their beliefs are and what they find difficult. . .rather than having one eye watching the clock.” “(Private room is helpful because). . .talking about what things are difficult without feeling that other people can hear through their curtain.” Discussion and conclusions: Physiotherapists found PACT was acceptable and feasible, fitted with but expanded with their role and competencies, had no fundamental barriers to implementation, with caveats about changes necessary to current practice and facilities. Impact and implications: These findings suggest PACT could successfully broaden the scope of practice of physiotherapists treating persistent back pain and inform future research in this area. Funding acknowledgement: The PACT study was funded by NIHR RfPB. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health in England. http://dx.doi.org/10.1016/j.physio.2016.10.285 POS229 Physiotherapy students and practice-based educators’ experiences of using placement passports during their practice-based education S.-J. Ryan ∗ , J. Morris University of Brighton, Health Sciences, Eastbourne, United Kingdom Relevance: Health professional students all undertake practice education in a range of practice settings. These placements form a mandatory and integral part of their programme of study and are essential in order to prepare them for their future role as health professionals. One of the commonly used tools that is used to facilitate students as adult learners on placement is the negotiated learning agreement or learning contract (Cross et al., 2006). This facilitation tool provides a useful framework that promotes discussion between student and educator encouraging students to identify their learning needs, establish learning outcomes and to discuss evidence that will be used to assess the learning outcomes (Cross et al., 2006). However anecdotally and some research suggests that students particularly those on first placements find it chal-
eS231
lenging to identify their learning needs and establish realistic learning goals. Purpose: The aim of this study is to explore physiotherapy students and practice based educators experiences of using placement passports before and during placement. Methods/analysis: The methodological approach employed will be phenomenological in nature as it acknowledges the individuals unique experience and how they have come to form their world view (Nicholls, 2009b). Sampling included final year students on a pre-registration Rehabilitation Science Masters and Bachelor of Science Physiotherapy at the University of Brighton (UoB) and practice based educators who were supporting students locally and were alumni of the UoB. Purposive sampling was chosen as it provided participants with meaningful insight in the phenomena of using the placement passport in identifying own learning needs to gain the most from their practice placement experience. A series of semi-structured interviews were carried out with final year students and practice based educators exploring this concept. The interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis (Braun & Clarke, 2006). Results: Preliminary findings indicate that students found that the passports allowed them to disclose previous experiences particularly struggles and areas for development that encouraged them to be more open during the negotiation of the learning contract. It was felt that it made the learning contract more individualised. Practice based educators discussed the usefulness of gaining insight into the student prior to the placement and giving them time to reflect on best ways of supporting to help the student achieve their best within the confines of service provision. Discussion and conclusions: The placement passport that has been designed to support students’ prior disclosure of learning needs including additional learning needs. Our aim was to facilitate disclosure across the whole cohort and to encourage students to identify their strengths and areas for development that help in the negotiation phase of learning agreements. Impact and implications: A range of learning and teaching approaches are used to enable students and practice educators to work together to ensure that students learning needs are met and patient safety and quality of care is given the highest priority (Cross et al., 2006). Funding acknowledgement: University of Brighton Clinical Research Centre for Health Sciences Staff Internal Research Grants. http://dx.doi.org/10.1016/j.physio.2016.10.286