Becoming confidently competent: a qualitative investigation of training in cognitive functional therapy for persistent low back pain

ABSTRACT

Background

Physiotherapists trained to deliver biopsychosocial interventions for complex musculoskeletal pain problems often report difficulties in confidence and competency at the end of training. Cognitive Functional Therapy (CFT) is an individualized biopsychosocial intervention and understanding the facilitators and barriers to training in CFT will help inform future training programs. This study aimed to explore physiotherapists’ and trainers’ perceptions of the process of developing competency in CFT.

Methods

A cross-sectional qualitative design using interviews of 18 physiotherapists and two trainers investigated training in CFT for persistent LBP via reflexive thematic analysis.

Results

Physiotherapists reported undergoing a complex behavior change process during training. Four themes emerged: 1) Pre-training factors; 2) Behavior change process; 3) Physiotherapy culture and context; and 4) Confident competence and beyond. Key components included graduated practice exposure linked to experiential learning with feedback and clear competency guidelines. Pre-training and contextual factors were facilitators or barriers depending on the individual. Physiotherapists supported ongoing learning, even after competency was achieved.

Conclusions

This study provides insight into the processes of change during progress toward competency in CFT. It highlights facilitators and barriers to competency including physiotherapy culture and the clinical environment. The study also describes important educational components, including experiential learning and clinical integration, which may be used to inform future post-graduate training.

KEYWORDS:

• Biopsychosocial
• physiotherapist
• training
• competency
• qualitative

Acknowledgements

The authors would like to acknowledge the 18 physiotherapists and trainer Dr JP Caneiro for their insights.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Supplemental data

Supplemental data for this article can be accessed online at https://doi.org/10.1080/09593985.2022.2151333

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.