Guidelines advocate a combined physical and psychological approach to musculoskeletal management of non-specific chronic low back pain (NSCLBP), referred to as psychologically informed practice (PIP). Extending the traditional scope of practice to include psychosocial domains has proved challenging for physiotherapists. Using Cognitive Functional Therapy (CFT) as an exemplar of a PIP approach for NSCLBP, this thesis developed and evaluated a training programme in CFT, to investigate the barriers to embedding PIP into primary care; with the intention of enhancing intervention fidelity for future clinical trials (see Figure 1 for a summary of the research phases).
Methods: The perceptions of physiotherapists pre-training on managing NSCLBP from a bio-psychosocial (BPS) perspective (Chapter 2), and their perceptions after the training programme on its impact on managing NSCLBP (Chapter 5), were evaluated using thematic analysis. Communication practice was analysed pre-training (Chapter 3) and post-training (Chapter 6) using conversation analysis. Chapter 4 describes the design and delivery of the multi-faceted CFT training programme.
Results: The pre-training qualitative study (Chapter 2) demonstrated that while physiotherapists recognised the value of a multi-dimensional BPS approach, there were challenges to addressing psychological factors, and to engaging patients to self-manage their condition. The pre-training assessment of their communication practice (Chapter 3) demonstrated a spectrum of communication styles ranging from physiotherapist-focused to a patient-focused collaborative approach. A formal training programme in CFT produced self-reported changes in physiotherapists’ attitudes, confidence and communication practice (Chapter 5). Finally, it was shown that the training programme had the capacity to influence communication practice, with physiotherapists demonstrating a more patient-focused and collaborative approach post-training (Chapter 6).

Conclusion: The findings in this thesis demonstrate that although physiotherapists recognise the importance of managing NSCLBP from a multi-dimensional perspective, they felt ill-equipped to integrate the wider psychological dimensions into their practice. However, a CFT training programme demonstrated capacity to improve physiotherapists’ self-reported confidence/ competence and produced changes in professional practice.