Experiences and practices of Australian physiotherapists with clients experiencing psychological distress

Although physiotherapists are not the first health professionals that most people would think of when it comes to working with people experiencing psychological distress, it has long been recognised that physiotherapists are likely to encounter people experiencing difficult periods in life. Despite this recognition, few studies have investigated physiotherapists’ experiences and practices with clients experiencing psychological distress. The program of research reported in this thesis investigated physiotherapists’ experiences and practices with clients experiencing psychological distress using a modified exploratory sequential mixed-methods approach conducted in three phases.

Phase one involved a qualitative interview study with 23 Australian physiotherapists and was the primary element of the program of research. This study investigated the experiences of physiotherapists with clients experiencing psychological distress. Two articles were published; one focused on the emotional experiences of physiotherapists when encountering clients experiencing psychological distress, and the other focused on the perceptions of physiotherapists regarding the forms of psychological distress they report having encountered. Key findings from this study were that encounters with clients experiencing psychological distress were perceived to be common, and there was a high degree of variability in the forms of psychological distress encountered. While emotional reactions in response to contact varied, some physiotherapists reported emotional exhaustion associated with repeated contact.

Phase two involved a cross-sectional survey of 340 Australian physiotherapists. Two articles were published, with the first investigating physiotherapists’ frequencies of contact with clients experiencing psychological distress and the second investigating physiotherapists’ frequencies of contact with clients with suicidal thoughts and behaviours. Physiotherapists’ frequency of contact with clients perceived to be experiencing psychological distress, expressed as a proportion of all clients seen each week, was 36.1%. While much less common, over half the respondents reported encountering clients at least once a year who disclosed suicidal thoughts. Compared to factors related to the physiotherapists themselves (e.g., psychosocial orientation), factors related to the clinical setting were stronger predictors of frequency of contact with clients perceived to be experiencing psychological distress (e.g., area of practice). While the identification of psychological distress was generally viewed as within the scope of the physiotherapy profession, there was no consensus regarding whether the assessment of psychological distress fell within or outside the physiotherapy scope of practice.

Phase three comprised a qualitative interpretive systematic mapping review, which mapped recommended approaches for physiotherapists to identify, assess, and manage psychological distress, reported in 40 eligible international articles. The review was conducted with the intention of gaining an understanding of expert recommendations regarding the role, scope, and approaches of physiotherapists working with clients experiencing psychological distress. The review revealed that it is commonly recommended that physiotherapists assess and manage health-related distress; however, there are relatively few recommendations regarding the role of physiotherapists in working with clients experiencing other forms of psychological distress.

The program of research highlights that Australian physiotherapists’ encounters with clients experiencing psychological distress are common and present emotionally and clinically challenging situations. Consequently, there is a need for (i) clarity regarding the roles of Australian physiotherapists in working with clients experiencing psychological distress, (ii) training in mental health and suicide prevention for Australian physiotherapists, and (iii) support for Australian physiotherapists regarding the emotional aspects of their work.