The application of psychologically informed practice: observations of experienced physiotherapists working with people with chronic pain.

OBJECTIVES: Psychologically informed practice (PIP) is advocated for physiotherapists to help people with chronic pain. There is little research observing how PIP is delivered in clinical practice. This study describes behaviours and techniques used by experienced physiotherapists working with groups of people with chronic pain. SETTING AND PARTICIPANTS: Experienced physiotherapists (n=4) were observed working with groups of people with chronic pain in out-patient pain management, and physiotherapy departments, in a large UK city centre teaching hospital. DESIGN: We observed the clinical behaviours and interpersonal skills of experienced psychologically informed physiotherapists, enriched by their accounts of intentions. The physiotherapists were audio and video recorded delivering group movement sessions. Recordings were reviewed with the physiotherapists for elaboration of intentions, then thematically analysed for comparison with defined CBT competencies. RESULTS: Four themes representing physiotherapist intentions when working with people with chronic pain were identified; building a therapeutic alliance, reducing perceived threat, reconceptualising beliefs and somatic experience, and fostering self-efficacy. The physiotherapists also reflected on challenges including engaging patients in self-management, encouraging activity and reinforcing rather than correcting movement. Considerable overlap existed between the observed behaviours in this study and existing CBT competencies. CONCLUSIONS: This paper complements current recommendations for delivering psychologically informed physiotherapy by providing examples of these skills being used in clinical practice. Further research supporting the development of training for, and mentoring of, physiotherapists, to promote competence and confidence in delivering psychologically informed interventions is recommended.

Anticyclonic eddies are more productive than cyclonic eddies in subtropical gyres because of winter mixing.

Mesoscale eddies are ubiquitous features of ocean circulation that modulate the supply of nutrients to the upper sunlit ocean, influencing the rates of carbon fixation and export. The popular eddy-pumping paradigm implies that nutrient fluxes are enhanced in cyclonic eddies because of upwelling inside the eddy, leading to higher phytoplankton production. We show that this view does not hold for a substantial portion of eddies within oceanic subtropical gyres, the largest ecosystems in the ocean. Using space-based measurements and a global biogeochemical model, we demonstrate that during winter when subtropical eddies are most productive, there is increased chlorophyll in anticyclones compared with cyclones in all subtropical gyres (by 3.6 to 16.7% for the five basins). The model suggests that this is a consequence of the modulation of winter mixing by eddies. These results establish a new paradigm for anticyclonic eddies in subtropical gyres and could have important implications for the biological carbon pump and the global carbon cycle.

Comparison of conventional resistance training and the fly-wheel ergometer for training the quadriceps muscle group in patients with unilateral knee injury.

A fly-wheel ergometer (FWE) offering resistance training of the knee extensors has been designed for space travel and found to be effective during bed rest. The possibility exists that this device is also effective in training the knee extensors after knee injury. The purpose of this study was to compare the FWE to standard knee extensor training equipment for their effects on individuals with a history of knee injury, a group who commonly suffer from weakness of the knee extensors that effects their function. Twenty-nine subjects completed the study, which included tests of knee self-assessment, knee extensor static and dynamic muscle strength, size and neural activation as well as single leg power output, standing balance and vertical jump performance. Both groups showed statistically significant (P < 0.05) improvements in these variables over the 3-month training period but no differences were noted between the groups. The FWE appears to be as effective as standard resistance training equipment for improving knee extensor muscle group size and performance after knee injury.