Persistent Pain: Physiotherapy Student Experiences of Person-Centred Care in Musculoskeletal Outpatient Departments

Aneurin James Claydon, Graeme Paul-Taylor


Person-centred care is championed throughout healthcare and emphasised in the management of persistent pain. Research reports that physiotherapists and physiotherapy students have struggled to integrate person-centred care into their practice and clinical work with people experiencing persistent pain. The aim of the study was to explore physiotherapy students’ experiences of person-centred care with people with persistent pain in a musculoskeletal outpatients’ placement setting, and to understand what affects physiotherapy students’ ability to implement person-centred practice. An interpretive qualitative method was used with data being collected by semi-structured focus groups of a purposive sample of undergraduate final-year physiotherapy students. A thematic approach to data analysis was completed using a cyclical immersive process. Three themes emerged: understanding of person-centred care, learning, and influences on clinical practice. The students showed an understanding of person-centred care in line with current literature. Person-centred care was generally deemed ‘well taught’ at university however this did not translate into their practice in a placement setting. Several factors influenced their ability to implement person-centred care, and this impacted upon their learning and their management of people presenting with persistent pain. In conclusion, physiotherapy students struggled to integrate learning of person-centred care from university into their practice on a musculoskeletal outpatient’s placement. It is recommended that physiotherapy course teams consider their curricula so that university and placement teaching facilitate person-centred learning and improve the management of persistent pain.


persistent pain; person-centred care; physiotherapy; practice-based learning

Full Text:



Barbour, R. (2007) Doing focus groups. London: Sage

Barbour, R. (2014). Introducing qualitative research: a student’s guide. 2nd edn. London: Sage

Bevan Commission (2015) A Prudent Approach To Health: Prudent Health Principles. [online]. available from [6 November 2017]

Braun, V., and Clarke, V. (2006) ‘Using thematic analysis in psychology’. Qualitative Research in Psychology, 3 (2), 77–101

Briggs, E.V., Carrl, E.C.J., and Whittakerl, M.S. (2011) ‘Survey of undergraduate pain curricula in healthcare professionals in the United Kingdom’. European Journal of Pain, 15, 789–795.

Chartered Society of Physiotherapy. (2017a) Code of Members' Professional Values and Behaviour’. [online]. available from [30 October 2017]

Chartered Society of Physiotherapy (2017b) Quality Assurance Standards for Physiotherapy Service Delivery. [online]. available from [30 October 2017]

Colleary, G., O’Sullivan, K., Griffin, D., .Ryan, C.G., and Martin, D.J. (2017). ‘Effect of pain neurophysiology education on physiotherapy students’ understanding of chronic pain, clinical recommendations and attitudes towards people with chronic pain: A randomised controlled trial’. Physiotherapy. [preprint]

Collins, A. (2014) Measuring What Really Matters: Towards a Coherent Measurement System to Support Person-Centred Care. Health Foundation, Thought Paper. [online]. available from [15 March 2017]

Cooper, K., Smith, B.H., and Hancock, E. (2009) ‘Patients’ perceptions of self-management of chronic low back pain: Evidence for enhancing patient education and support’. Physiotherapy, 95 (1) 43–50.

Cruz, E.B., Caeiro, C., and Pereira, C. (2014) ‘A narrative reasoning course to promote patient-centred practice in a physiotherapy undergraduate programme: A qualitative study of final year students’. Physiotherapy Theory and Practice, 30 (4), 254–260.

de Silva, D. (2011) ‘Helping People Help Themselves: A Review of the Evidence Considering Whether it is Worthwhile to Support Self-Management’. Health Foundation Evidence Report. [online]. available from [15 March 2017]

Department of Health (2000) The NHS Plan: A plan for Investment, A Plan for Reform. [online]. available from [15 March 2017 ]

Donaldson, L. (2009). 150 Years of the Annual Report of the Chief Medical Officer (2008). [online]. available from [15 March 2017]

Etherton, J. and Waterfield, J. (2015) ‘Preparing to manage patients in pain. The student perspective: A pilot’. Pain and Rehabilitation - the Journal of Physiotherapy Pain Association, 38, 27–33

Francis, R. (2013) Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. London: The Stationery Office [online]. available from [19 March 2017]

Hunt, A., Adamson, B., and Harris, L. (1998) ‘Physiotherapists' perceptions of the gap between education and practice’. Physiotherapy Theory and Practice, 14 (3), 125–138

Hunt, A., Adamson, B., Higgs, J. and Harris, L. (1998) ‘University education and the physiotherapy professional’. Physiotherapy 84 (6), 264–273

Hunter, J.P. and Simmonds, M.J. (2010) ‘Pain: Putting the whole person at the centre’. Physiotherapy Canada, 62 (1). 1–4.

International Association for the Study of Pain (2017) ‘IASP Curriculum Outline on Pain for Physical Therapy’. [online]. available from [15 March 2017]

Jones, L. (2009) ‘Implications of IASP core curriculum for pre-registration physiotherapy education’. British Journal of Pain, 3 (1), 11–15

Jones, L. and Hush, J.M. (2011) ‘Pain education for physiotherapists: Is it time for curriculum reform?’ Journal of Physiotherapy [online]. 57 (4), 207–208. available from [2 July 2017]

Lindquist, I., Engardt, M., Garnham, L., Poland, F., and Richardson, B. (2006) ‘Physiotherapy students’ professional identity on the edge of working life’. Medical Teacher, 28 (3), 270–276.

Litosseliti, L. (2003) Using Focus Groups in Research. London: Continuum.

Mead, N. and Bower, P. (2000) ‘Patient-centeredness: A conceptual framework and review of the empirical literature’. Social Science & Medicine, 51 (7), 1087–1110

Melzack, R. (1999) ‘From the gate to the neuromatrix’. Pain [online]. 82 (supplement 1), S121-S126. available from [2 July 2017]

Moseley, G.L. (2003) ‘A pain neuromatrix approach to patients with chronic pain’. Manual Therapy, 8 (3), 130–140

Moseley, G.L. (2007) ‘Reconceptualising pain according to modern pain science’ Physical Therapy Reviews, 12, 169–178.

Mudge, S., Stretton, C., and Kayes, N. (2014) ‘Are physiotherapists comfortable with person-centred practice? An autoethnographic insight’. Disability and Rehabilitation, 36 (6), 457–463.

National Institute for Health and Care Excellence (NICE) (2012) ‘Patient Experience in Adult NHS Services’. [online]. available from [15 March 2017]

Neuman, W.L. (2011) Social Research Methods: Qualitative and Quantitative Approaches. 7th edn. London: Pearson.

O’Sullivan, P. (2012) ‘It’s time for change with the management of non-specific chronic low back pain’. British Journal of Sports Medicine, 46, 224–227.

Pelzang, R. (2010) ‘Time to learn: Understanding patient-centred care’. British Journal of Nursing, 19 (14), 912–917.

Petty, N.J. (2009) ‘Towards clinical expertise: learning transitions of neuromusculoskeletal physiotherapists’. [online]. Doctoral thesis. University of Brighton. available from [19 March 2017]

Petty, N.J., Scholes, J., and Ellis, L. (2011) ‘Master’s level study: Learning transitions towards clinical expertise in physiotherapy’. Physiotherapy, 97 (3), 218–225.

Physiotherapy Pain Association (2014) ‘Physiotherapy framework – Entry level graduate to Expert: Describing the Values, Behaviours, Knowledge and Skills of Physiotherapists Working with People in Pain’. [online]. available from [15 March 2017]

Roskell, C., Hewison, A., and Wildman, S. (1998) ‘The theory-practice gap and physiotherapy in the UK: Insights from the nursing experience’. Physiotherapy Theory and Practice, 14 (4), 223–233.

Roskell, C., White, D. and Bonner, C. (2013) ‘Developing patient-centred care in health professionals: reflections on introducing service-learning into the curriculum’. International Journal of Therapy and Rehabilitation, 19 (8), 448–456.

Ross, E.F. and Haidet, P. (2011) ‘Attitudes of physical therapy students toward patient-centered care, before and after a course in psychosocial aspects of care’. Patient Education and Counseling, 85 (30), 529–532.

Sanders, T., Foster, N.E., Bishop, A., and Ong, B.N. (2013) ‘Biopsychosocial care and the physiotherapy encounter: Physiotherapists’ accounts of back pain consultations’. BMC Musculoskeletal Disorders, 14 (65).

Schmitt, J., Akroyd, K., and Akroyd, L. (2012) ‘Perceptions of physiotherapy students of a person-centred approach in rehabilitation’. International Journal of Therapy and Rehabilitation 19 (1), 23–30.

Synnott, A., O’Keeffe, M., Bunzli, S., Dankaerts, W., O'Sullivan, P., & O'Sullivan, K. (2015) ‘Physiotherapists may stigmatise or feel unprepared to treat people with low back pain and psychosocial factors that influence recovery: A systematic review’. Journal of Physiotherapy, 61 (2), 68–76.

Watt-Watson, J., McGillion, M., Hunter, J., Choiniere, M., Clark, A.J., Dewar, A., . . . Webber, K. (2009) ‘A survey of prelicensure pain curricula in health science faculties in Canadian universities’. Pain Research and Management, 14, 439–444



  • There are currently no refbacks.

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

ISSN 2051-6223