Barriers and facilitators to student physiotherapists’ use of psychological interventions in physiotherapy practice

Purpose
This study explored student physiotherapists’ attitudes and beliefs towards the use of psychological interventions in physiotherapy practice. The primary objectives were to identify students’ perceived barriers and facilitators to physiotherapists conducting psychological interventions, in order to inform initiatives to increase their future engagement in conducting psychological interventions.

Methods
The Modified Nominal Group Technique (NGT) consensus development method was used to collect qualitative and quantitative data from 18 MSc Physiotherapy (pre-registration) students. Participants provided written responses to the following questions: What do you consider to be the a) barriers and b) facilitators to conducting psychological interventions in physiotherapy practice? From the generated responses, participants ranked their top five items that they felt were most pertinent to each question. Those ranked by at least 30% of participants were thematically grouped and median rank scores were calculated to enable rank ordering.

Results
42 barriers and 32 facilitators were generated, of which 33 were ranked and themed. Following rank ordering, the most prevalent barriers related to lack of education; time constraints; lack of experience; inappropriate environments; fear; outside scope of practice; and discomfort. One stated: “I don’t understand why a physiotherapist would be doing psychological interventions. Surely a psychologist should be doing that”. The main facilitators cited included: placements in mental health practice; education; additional time; encouragement from practice educators; clear guidelines; and personal experiences of mental health difficulties. One said: “I’d definitely address mental health if I had the time“.

Conclusion(s)
A large number of barriers and facilitators were cited by the students, with education and time, or its lack, ranked highly for both questions. Concerningly, they felt that psychological interventions were outside of the scope of physiotherapy practice; however, a key facilitator included encouragement from practice educators and clear guidelines. The findings suggest that a review of pre-registration curricula in the UK is recommended, in order to integrate sufficient psychology-based education. Additionally, the critical importance of updating and training practice educators was highlighted, as they provide powerful role modelling for students. Further research is required to evaluate the effectiveness of strategies aimed at equipping student physiotherapists with psychological techniques for their evolving scope of practice.

Implications Ultimately, negative attitudes and beliefs towards addressing mental health difficulties will hinder optimal person-centred care and holistic treatment delivery. It is recommended that a review of UK physiotherapy pre-registration curricula is conducted in order to standardise the mental health content of UK physiotherapy, in order to facilitate a cohesive level of training for all student physiotherapists. Universities could considerably enhance students’ practice by integrating mental health education and advanced communications skills, including low-intensity cognitive behavioural therapy interventions, into curricula. Furthermore, Universities are encouraged to make mental health settings a more accessible and common placement experience, whereby students can upskill under the guidance of specialist mental health practice educators