“A light bulb moment!” Experiences of delivering Physiotherapy informed by Acceptance and Commitment Therapy (PACT)

Abstract

Background Chronic low back pain (CLBP) is a common cause of pain, disability and time off-work in the UK. It generates considerable suffering and costs the NHS over £1 billion a year. Current physiotherapy treatments are moderately effective. Combining theory-based psychological methods with physiotherapy could improve outcomes for people with CLBP. Physiotherapy informed by Acceptance and Commitment Therapy (PACT) is a novel treatment being evaluated in the PACT trial ( www.controlled-trials.com/ISRCTN95392287). This nested longitudinal qualitative study aimed to explore the feasibility and acceptability of PACT training and treatment delivery. Methods Individual semi-structured interviews were conducted by independent researchers. Physiotherapists were interviewed three times over 18 months: after training, six months later and at the end of treatment delivery. Interviews were audio recorded, transcribed verbatim and analysed using the framework approach to generate key themes. Respondent validity and independent coding by another researcher were conducted to check the validity of emergent themes. Findings Eleven physiotherapists (Band 6–8; mean age 40 years, range 26–52; 8 females) from three NHS hospital trusts in SE England were interviewed. Four themes emerged: 1) Barriers and facilitators to implementing training 2) Value of supervision and support throughout the trial 3) Challenging personal and patient responses 4) Importance of context for translation into routine care. Discussion PACT was acceptable and feasible, with positive perceived outcomes regarding the development of competency and facilitation of self-management. Findings suggest PACT could successfully broaden the scope of practice of physiotherapists treating CLBP and inform future research in this area.