Communication skills in the context of psychological flexibility: training is associated with changes in responses to chronic pain in physiotherapy students in Spain

Abstract

Se pretende conocer si un entrenamiento en habilidades desde la perspectiva de la flexibilidad psicológica puede modificar las actitudes y creencias frente al dolor crónico en estudiantes de fisioterapia (actitudes hacia enfoques biomédico y biopsicocial, creencia de que el dolor es altamente incapacitante y evitación experiencial). Metodología: Estudio piloto preexperimental pre-post con seguimiento en 35 estudiantes universitarios de Fisioterapia. Se realizó una intervención educativa mediante un protocolo adaptado de la Terapia de Aceptación y Compromiso (Hayes et al., 2012) en grupos reducidos implementada por psicólogos con una duración de 10 horas. La intervención se centró en el desarrollo de: a) escucha activa/validación, b) adherencia terapéutica y c) aceptación psicológica. El impacto de la intervención fue evaluado a través de los cuestionarios estandarizados PABS-PT, HC-PAIRS y AAQ-II (mide evitación experiencial) y de un cuestionario de satisfacción. El seguimiento se realizó a los 2 meses. La intervención fue acompañada de cambios en actitudes y creencias, en la dirección esperada. Entre las limitaciones del estudio hay que señalar la ausencia de grupo control y el número reducido de participantes.The aim of this study is to explore the effectiveness of a training program aimed at managing patients chronic pain in physiotherapy students in Spain. The program addressed providing them with efficient skills to manage patients chronic pain from psychological flexibility (PF) perspective. The program integrates communication skills training into PF-based training. It sought to contribute to better recognize the role of psychosocial factors in chronic pain and to better promote adherence to treatment. This is an observational study with a pre- and post-training program design and a 2-month follow-up. A total of 35 physiotherapy students, divided into three groups, participated in a 10-hour training course. The training focused on three areas: (1) communication skills, (2) therapeutic adherence and (3) managing distress and pain. The three areas were addressed from the PF point of view. Impact of training was measured through standardised questionnaires that assessed attitudes towards chronic pain, an ad hoc questionnaire that assessed responses to difficult communicative situations and a training satisfaction scale. Final analyses showed that attitudes changed significantly after training, biomedical attitude scores decreased and biopsychosocial attitude increased, while pain was considered less disabling, and informed empathic responses in communication situations increased. These changes were maintained at 2-month follow-up. Satisfaction with the training was high. We conclude that a brief training program based on the PF model may help students develop a more comprehensive approach and improve their skills for managing chronic pain.