By Caroline Heaney
Physiotherapists are healthcare professionals involved in the treatment and rehabilitation of a broad range of patients in a variety of settings (e.g. hospitals, clinics, and sports clubs). This means that physiotherapy training and practice needs to cover a diverse spectrum of areas. Physiotherapy, as suggested by its name, is primarily concerned with the physical condition and has traditionally focused on just the physical aspects of injury and impairment. More recently however, consideration of the psychological condition during treatment has grown in importance. In line with this in recent years there has been a move away from the biomedical model towards the biopsychosocial model in physiotherapy practice.
Although UK bodies such as the Chartered Society of Physiotherapy (CSP) and Health and Care Professions Council (HCPC) acknowledge that an understanding of psychology is important to effective physiotherapy practice, and research has consistently shown the importance of psychological factors in physiotherapy, there appeared to be little known about psychology education within UK physiotherapy programmes and how effective this education is. A literature search failed to find any recent investigations examining the psychology content of UK programmes. In fact the most recent detailed investigation was published in 1989. We therefore decided to undertake our own investigation titled ‘A Qualitative and Quantitative Investigation of the Psychology Content of UK Physiotherapy Education Programs’.
The aim of this investigation was to examine current psychology provision within UK physiotherapy programmes to see if progress has been made since Baddeley and Bithell’s investigation in 1989. Specifically, the investigation aimed to examine the nature and extent of psychology covered in physiotherapy programmes. Representatives from seventeen UK universities that run physiotherapy programmes endorsed by the CSP and HCPC were interviewed regarding the psychology content of their physiotherapy programmes.
What did we find?
All of the universities claimed to include some degree of psychology content within their physiotherapy programmes, with health psychology being the most commonly cited topic area taught. It was largely agreed that psychology is an important component in the education and training of physiotherapists. However, there appeared to be great diversity both within and between universities in the provision of psychology education, and an underlying inconsistency between the reported importance of psychology and the demonstrated importance of psychology through its visibility within physiotherapy programmes. Such diversity and inconsistency was also reported by Baddeley and Bithell (1989), perhaps indicating that limited progress has been made in standardising the psychology curriculum for physiotherapy students over the last twenty-five years.
With regard to the delivery of psychology content, most universities used an integrated approach where psychology content was embedded into other aspects of the curriculum rather than delivered in discrete chunks or modules. The key reason cited for this was that of contextual relevance; it was largely felt that an integrated approach to the delivery of psychology content would lead to a more applied understanding of the topic. It was beyond the scope of the study to accurately determine whether or not the integrated approach to psychology content delivery is effective, however, it is possible that such an approach could sideline or de-emphasise the importance of psychology in physiotherapy practice. It has been suggested that an integrated approach may have a negative impact on confidence in using psychology. Another concern is that this approach can lead to vast inconsistencies in the volume and quality of psychology taught, both between and within universities, and difficulties in quantifying the amount of psychology covered. In line with this, when questioned regarding the amount of psychology in their physiotherapy programme, most were unable to provide an estimate and those who did varied greatly with responses ranging from 5-80%.
Key to a thorough understanding of psychology in an applied context is an understanding of the theoretical underpinning. Therefore, it would be reasonable to expect that the psychology content of physiotherapy programmes would contain a strong theoretical underpinning. However, this was not the case for all universities, with 41% of participants indicating that their psychology provision did not contain any theoretical underpinning. This is suggestive of a degree of superficial coverage of psychology amongst these institutions, which could potentially disadvantage students. One way of improving this situation would be for bodies such as the CSP and HCPC to set more prescriptive guidelines in this area.
The majority of participants rated psychology as highly important in the training of physiotherapists, stating the need for a holistic approach and an understanding of people and behaviour as the key reasons for this. However, this begs the question as to why its coverage is often hidden and why such inconsistency remains between universities in the nature and extent of their coverage. One answer to this may lie in the sheer volume of content required to be covered in physiotherapy programmes. Whilst this study focussed on the psychology content of physiotherapy programmes it is important to note that physiotherapy students have to cover a vast number of other topic areas. When asked what factors dictate the amount of psychology that is covered, time/space in the curriculum was the most commonly cited answer. The second most common answer related to staff; namely the quality, enthusiasm and availability of staff. It seemed that universities were only able to provide good psychology provision when they had access to staff able to facilitate this, which was not always possible.
It is clear that many physiotherapy programmes in the UK provide students with an appropriate grounding in psychology that will positively impact upon their professional practice and that these universities contain strong advocates for psychology amongst their staff. However, this is not always the case and there appears to be great variance in the psychology provision within physiotherapy programmes, which could potentially disadvantage some students. The findings from our study suggest that more needs to be done to standardise the psychology content of physiotherapy programmes in order to ensure that students at all institutions receive a similar level of training in psychology, which will have a positive impact on their professional practice.