A1 Journal article (refereed)
Becoming confidently competent : a qualitative investigation of training in cognitive functional therapy for persistent low back pain (2024)

Simpson, P., Holopainen, R., Schütze, R., O’Sullivan, P., Smith, A., & Kent, P. (2024). Becoming confidently competent : a qualitative investigation of training in cognitive functional therapy for persistent low back pain. Physiotherapy Theory and Practice, 40(4), 804-816. https://doi.org/10.1080/09593985.2022.2151333

JYU authors or editors

Publication details

All authors or editorsSimpson, Phoebe; Holopainen, Riikka; Schütze, Robert; O’Sullivan, Peter; Smith, Anne; Kent, Peter

Journal or seriesPhysiotherapy Theory and Practice



Publication year2024

Publication date24/11/2022


Issue number4

Pages range804-816

PublisherTaylor & Francis

Publication countryUnited Kingdom

Publication languageEnglish


Publication open accessNot open

Publication channel open access

Publication is parallel published (JYX)https://jyx.jyu.fi/handle/123456789/85635


Physiotherapists trained to deliver biopsychosocial interventions for complex musculoskeletal pain problems often report difficulties in confidence and competency at the end of training. Cognitive Functional Therapy (CFT) is an individualized biopsychosocial intervention and understanding the facilitators and barriers to training in CFT will help inform future training programs. This study aimed to explore physiotherapists’ and trainers’ perceptions of the process of developing competency in CFT.

A cross-sectional qualitative design using interviews of 18 physiotherapists and two trainers investigated training in CFT for persistent LBP via reflexive thematic analysis.

Physiotherapists reported undergoing a complex behavior change process during training. Four themes emerged: 1) Pre-training factors; 2) Behavior change process; 3) Physiotherapy culture and context; and 4) Confident competence and beyond. Key components included graduated practice exposure linked to experiential learning with feedback and clear competency guidelines. Pre-training and contextual factors were facilitators or barriers depending on the individual. Physiotherapists supported ongoing learning, even after competency was achieved.

This study provides insight into the processes of change during progress toward competency in CFT. It highlights facilitators and barriers to competency including physiotherapy culture and the clinical environment. The study also describes important educational components, including experiential learning and clinical integration, which may be used to inform future post-graduate training.

Keywordsphysiotherapyspinal diseasesphysical therapistseducation and trainingcontinuing professional educationknow-howcompetenceexperiential learning

Free keywordsbiopsychosocial; clinical integration

Contributing organizations

Ministry reportingYes

Reporting Year2022

JUFO rating1

Last updated on 2024-22-04 at 17:03