Physical therapists’ experiences of learning and delivering a complex behavioral medicine intervention to adolescents with pain

Figures & data

Table 1. The content of PTs education in behavioral medicine treatment

	Session 1	Session 2	Session 3	Session 4
Theory	Biopsychosocial model Theories; Operant Respondent Social cognitive Coping theory Fear avoidance Stages of change	Goal setting Self-monitoring Functional behavioral analysis (FBA)	Theoretical basis of treatment techniques; Physical Cognitive Emotional Social/environmental See Table 2 for details	Operant techniques to be used by patients and parents Lifestyle change techniques; Improve sleep and eating habits
Skills training		How to identify goal activities and introduce self-monitoring FBA skills training	Introduction and practicing of treatment techniques	Parental work Repetition of treatment techniques in practice
Home-work	Repetition of theoretical background	Identification of goal and self-monitoring of behavior own health behavior	Practicing FBAs Applied skills training with non-study patientsof treatment techniques	Monitoring of own learning process Assemble questions for supervision

Table 2. Specific techniques in the behavioral medicine treatment

Physical*	Cognitive	Emotional	Social
Improve strength circulation Posture control, Range of motion, Stabilization/muscular control, Coordination, Aerobic fitness	Alter automatic negative or catastrophic thoughts Positive self-talk Distraction Problem solving	Pain or movement related fears (graded exposure) General anxiety (Worry time) Basic and applied relaxation training	Asking and getting support from friends Getting support from parents

*The physical components included best clinical practices for exercises and followed recommendations for repetitions, load and intensity (Faigenbaum, Lloyd, and Myer, 2013).

Table 3. Categories, subcategories and codes

Categories	Subcategories	Codes
Learning BMT
Learning the theoretical concepts	Theory and new words	Theoretical New/Difficult words
	Well-balanced content	Extent of theory good
	Challenging concepts	FBA hard to learn To sort information difficult
Support in learning	Study cases	Examples of patients best
	Written materials	Manual good for learning
		Poster of BMT in treatment room
Understanding in practice	Theory anchored	Theory landed when meeting patients Understanding of theory progressed
	Supervision as learning	Supervision best for learning
		Supervision better than written materials
The need to feel confident	Rehearsal	Repetition to feel secure
	Improving skills	More knowledge for increased confidence Better when using a technique a few times
Delivering BMT
Positive perceptions	Holistic approach	More than biomedicine Working with whole person Positive gut feeling
	Working toward a goal	Patients understood importance of goal Valuable to return to goal activities Good structure for work Identification of goals provided focus Underline self-management
	Satisfaction with BMT	Distraction useful Tailoring Joy when patient altered behavior
	Parental work pillar for success	Chance for parents to ask Alter parents’ thoughts about pain Guiding parents how to support Make deals with parents
Frustrations	Abundant information	Gathering data for FBA took time Hard to fit it all in
	Insufficient results disappointing	Consequences difficult Hard when little change
	Excessive problems	Simultaneous pain problems Life problems
Dual experiences	Analysis crucial	Assessment and analysis critical Treatment onset delayed
	Self-monitoring	Facilitates insight Help in discussions Hard when data were sparse
	Thoughts and behaviors	Thoughts altered not behaviors Behaviors altered not thoughts
Behavioral medicine in daily practice	Positive outcomes	Better long-term outcomes Use new knowledge for all patients
	Continued supervisions	Supervision necessary
Practical prerequisites	Manual a must	Manual structure and order Manual provided confidence Pre-set explanations aided
	Understanding colleagues	Visits longer Time for reflection Understanding colleagues

Faigenbaum AD, Lloyd RS, Myer GD 2013 Youth resistance training: Past practices, new perspectives, and future directions. Pediatric Exercise Science 25: 591–604.

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