"Learning by osmosis": the transformative social identity journey of physiotherapists developing psychologically-informed practice, a reflexive thematic analysis

Abstract

Background: Despite efforts to support physiotherapists in integrating psychosocial aspects of care to biological ones, clinical practice remains dominated by biomechanistic priorities. To facilitate change, attention and actions need to consider not only the individual level of the therapists but also the cultural and structural levels of the profession. How these multi-layered social dynamics shape practice have not previously been investigated. The Social Identity Approach (SIA) provides a relevant framework to this exploration.

Aim: This study aimed to identify the social identity processes involved in the development of psychologically-informed physiotherapy (PIP) to understand how they may influence practice change.

Methods: Nine semi-structured interviews were conducted with self-identified psychologically-informed physiotherapists. A Reflexive Thematic Analysis informed by SIA principles enabled to consider meaning as the product of social processes.

Findings: The analysis of participants' experiences in moving from a primarily biomechanistic practice toward the integration of psychosocial aspects of health demonstrated: 1) a transformative "mind-blowing" identity journey; 2) a journey that is not made in isolation; and 3) where leadership matters.

Conclusion: Changes in clinical practice involve dynamics at the collective level of the practice environment and of the physiotherapy profession itself, rather than solely at the individual level of clinicians. An understanding of these complex social processes at a managerial level could be important to better support leaders and clinicians in implementing PIP in clinical practice.

Keywords: Physiotherapy; professional culture; psychologically-informed physiotherapy; reflective practice; social identity approach.