"Every patient teaches you something new": experiences of physiotherapists delivering cognitive functional therapy for chronic, disabling low back pain in a randomised controlled trial.

Abstract

Cognitive functional therapy (CFT) is an individualised person-centred biopsychosocial intervention that demonstrated large and sustained clinically important improvements in people with chronic, disabling low back pain (LBP) in the RESTORE randomised controlled trial. This study aimed to explore physiotherapists' experiences of delivering CFT in the RESTORE trial. Cross-sectional qualitative design using reflexive thematic analysis with interviews of 15 treating physiotherapists (3-25 years experience) across Perth and Sydney. The overarching theme was "<i>Driving on P(probationary)-plates</i>." The probationary driver analogy encompassed feelings of being newly competent, gaining experience, and refining competencies. Four themes were developed: "Sharing the journey of transformational change," "Refining new competencies," "Navigating patient complexity," and "Balancing patient care with trial-related processes." Physiotherapists described the life-changing improvements and re-engagement with valued activities of their patients under the theme of "Sharing the journey of transformational change." "Refining new competencies" described the continued enhancement of physiotherapists' new competencies towards an individualised and collaborative approach. The experiences of physiotherapists trained to deliver individualised, person-centred biopsychosocial care within an RCT can be likened to being a probationary driver. Experiential learning, ongoing support, and opportunities to navigate challenges with complex patients were important aspects of the journey towards mastery.