UK chartered physiotherapists’ personal experiences in using psychological interventions with injured athletes: An Interpretative Phenomenological Analysis

Objectives: Despite the gradual growth of psychology of injury literature, thus far few studies have investigated physiotherapists’ personal experiences in using psychology in their work. Therefore the purpose of this study was to explore the physiotherapists’ personal experiences in using psychological intervention techniques as part of sport injury rehabilitation. Design: This study adopted a qualitative approach when exploring chartered physiotherapists’ personal experiences in using psychological intervention methods in their work with injured athletes. Semistructured interview schedulewas devised and the data obtainedwas analyzed by using the Interpretative Phenomenological Analysis (IPA; Smith (1996)). Methods: Seven (4 female, 3 male) physiotherapists working in sports medicine in the United Kingdom participated in the interviews. Results: Following the IPA analysis, the physiotherapists in this study were very open about their lack of formal training in sport psychology, and appeared to be knowledgeable and comfortable in using goal setting and encouraging social support. Familiarity with, and experiences of using other techniques (i.e., imagery, relaxation, and self-talk) seemed to be less apparent. The physiotherapists also stressed the importance of ‘gut-feeling’ and experiential knowledge. Conclusions: The study provides a valuable insight into physiotherapists’ real-life experiences in using psychological interventions. Based on the findings, it can be recommended that further training on a range of psychological techniques would be useful. 2009 Elsevier Ltd. All rights reserved. Over the past thirty years, researchers in sport have explored psychological facets of sport injuries, and as a result, a large body of literature exists in support of addressing the psychological aspects of injuries during rehabilitation. For example, issues with athletes’ ability to cope with pain, stress and anxiety, and apprehensions related to self-efficacy, self-esteem, and confidence, along with problems associated with athletes’ motivation and rehabilitation adherence/compliance can all be facilitated through the use of psychological interventions (e.g., Beneka et al., 2007; Flint, 1998; Ievleva & Orlick, 1991; Taylor & Taylor, 1997) In order to reflect the mind-body approach to recovery process, if at all possible, the care provided should entail the involvement of relevant sport medicine professionals, as well as the use of sport psychologists (Green, 1992). All of the professionals involved in the ton.ac.uk (M.Arvinen-Barrow). All rights reserved. process should work closely together with the athlete towards a common goal in ensuring the athletes full physical and psychological recovery back to pre-injury level of performance. Having such a multi-disciplinary team working with injured athletes is common practice in professional sports (Wiese-Bjornstal & Smith, 1999); however unfortunately such is thought to be rarely the case amongst athletes involved in lower levels of participation. In a recent national study with UK physiotherapists, only 25.3% of the physiotherapists indicated that they had access to a qualified sport psychologist (Arvinen-Barrow, Hemmings, Weigand, Becker, & Booth, 2007). Amongst sport injury rehabilitation professionals working in professional football in England andWales however, the same figure was reported as 69% (Heaney, 2006), thus suggesting elite/professional athletes as being more likely to have an access to a sport psychologist. As psychological issues can play a significant part in any athletes’ recovery to full fitness, and only few physiotherapists appear to have access to a sport psychologist, addressing psychological issues M. Arvinen-Barrow et al. / Psychology of Sport and Exercise 11 (2010) 58–66 59 during rehabilitation often becomes the responsibility for the physiotherapists (e.g., Jevon & Johnston, 2003). A number of researchers (e.g., Gordon, Potter, & Ford, 1998; Gordon, Potter, & Hamer, 2001; Pearson & Jones, 1992; Wiese & Weiss, 1987; Wiese, Weiss, & Yukelson, 1991) have suggested that medical professionals in regular contact with the athlete during treatment are in an ideal position to inform, educate, and assist with both psychological and physical process of injury. Ray, Terrell, and Hough (1999) believe that medical professionals such as physiotherapists are an important source of emotional first aid to athletes during injury recovery, and should be utilizing a range of psychosocial counseling techniques and strategies with injured athletes. According to Harris (2005), physiotherapists should be skilled enough to recognize a range of psychological reactions experienced by injured athletes, and to have the skill-set to intervene (i.e., use basic psychological interventions), and in case of clinical issues (e.g., depression, substance abuse, and eating disorders), have the ability to recognize the need for referral. However, during their professional training, very rarely do physiotherapists receive the level of training required in the use of psychological interventions (Kolt & Andersen, 2004b). In fact, during their studies, physiotherapists may receive very little or no training in terms of how psychological techniques can facilitate recovery processes and how to use these techniques in their work with injured athletes (Taylor & Taylor, 1997). More recent literature suggests that while virtually all university and college physical and manual therapy programs do employ some psychology training, a high variation exists in the context and depth of the taught material (Kolt & Andersen, 2004b), and often the extent to which training is provided depends on the person planning and delivering the training (Harris, 2005). Given the importance of physiotherapist ability to address psychological facets of injuries, and in order to make recommendations for further training in these issues, exploring the role of physiotherapists in providing psychological support during injury rehabilitation can be considered vital. In the UK, past research in this area is limited and has included both quantitative and qualitative methodologies. Hemmings and Povey (2002) administered the physiotherapists and sport psychology questionnaire survey (PSPQ; Hemmings & Povey, 2002) to a sample of chartered physiotherapists in the Eastern region of England (N 1⁄4 90). A few years later, Heaney (2006) replicated Hemmings & Povey’s research with a sample of physiotherapists working in English professional football (N 1⁄4 39), and complemented the questionnaire responses with content analyzed semi-structured interviews with conveniently selected chartered physiotherapists (N 1⁄4 10). The most recent research to date using the PSPQ was a comprehensive national survey (N 1⁄4 361) amongst chartered physiotherapists working in sports medicine in the UK (Arvinen-Barrow et al., 2007). By surveying the physiotherapists’ views on sport psychology as part of their work, the aforementioned studies have been able to produce a large amount of quantitative data in relation to UK physiotherapists’ current views on the psychological facets of their practice. In all three studies, the physiotherapists agreed that on most occasions, sport injury will have an impact on an athlete psychologically. Physiotherapists also identified a range of psychological characteristics present in athletes who cope/do not cope successfully with their injury, with treatment compliance and attitude towards rehabilitation/injury listed as the most frequent characteristics in all three studies. The same studies also indicated a clear pattern in the use of, and desire for future training in range of psychological skills/techniques. The use of goal setting, creating variety in rehabilitation exercises, and encouraging athletes to use positive self-talk were reported as the most used techniques by the physiotherapists. The same skills/methods were also considered to be the most important techniques to learn more about. A similar pattern was also evident with the less frequently used techniques. Relaxation and imagery were used the least and were reported to be some of the least important skills/techniques physiotherapists wanted to learn more about. Arvinen-Barrow et al. (2007) proposed a range of suggestions as to why such patterns might be occurring. According to the authors, one of the reasons could be due to the level of knowledge of some of the techniques. Equally, the findings could also be due to past experiences in using such techniques. Furthermore, the results could be merely a reflection on the perceived characteristics of the techniques. As Arvinen-Barrow et al. and other similar studies in the UK (i.e., Heaney, 2006; Hemmings & Povey, 2002) used quantitative methods, (i.e., PSPQ questionnaire survey), the reasons for the emergent patterns have been left unclear. Thus far two qualitative studies investigating physiotherapists’ role in the psychological rehabilitation from injury in the UK have been published. A study by Jevon and Johnston (2003) was concerned with governing body chartered physiotherapists (N 1⁄4 19) perceived knowledge and attitudes towards psychological aspects of sport injury rehabilitation. Their findings suggested that the physiotherapists had built a wealth of knowledge on the psychology of injury through experiential learning. In addition, despite the lack of formal education in psychological theory and relevant intervention techniques, physiotherapists had also accepted the role of providing psychological support to the injured athletes. Physiotherapists’ accounts on the practicalities of providing psychological support (i.e., their experiences of using psychological intervention techniques) were not included in the topics covered. Similarly, study into physiotherapists ‘lived experiences’ with 10 chartered physiotherapists working with elite athletes deviated from the trend for evidence-based research by seeking practicebased evidence on the topic (McKenna, Delaney, & Phillips, 2002). The study used a phenomenological approach, and aimed to describe the physiotherapists’ lived experiences of treating elite athletes. In this study the physiotherapists felt that they have a major role in making sure that rehabilitation works for elite athletes. Physiotherapists also possessed understanding on different psychological intervention techniques; however applying such knowledge in their work was not demonstrated. As the research focus was on the physiotherapists’ accounts of the processes of treating elite athletes, and not specifically in physiotherapists’ experiences of using psychological intervention skills/ techniques on a practical level, further research is justified. In conclusion, it has been acknowledged that in order for the treatment to be effective, physiotherapists are required to address both physical and psychological aspects of injuries. Despite the gradual growth of psychology of injury literature, thus far no studies in the UK appear to have investigated physiotherapists’ personal experiences in using psychological intervention techniques in detail. Therefore the purpose of this paper is to explore the UK chartered physiotherapists’ personal experiences in using psychological intervention techniques as part of their work with injured athletes.