Abstract
Background and purpose
Spinal cord injury (SCI) is a life-changing condition with significant biopsychosocial impacts for the person. Supporting psychosocial adjustment is recognised as an important component of SCI rehabilitation, yet little is known about how physiotherapists contribute. Although psychosocially informed practice is increasingly advocated within contemporary physiotherapy, research has primarily focused on musculoskeletal and persistent pain contexts, with limited exploration in rehabilitation settings such as SCI. Furthermore, psychosocially informed practice remain variably defined, creating uncertainty regarding how they are understood and enacted in everyday clinical work. This study explored how physiotherapists support post-traumatic adjustment following SCI by integrating psychosocially informed practice. It also aimed to identify physiotherapists’ perceived learning and development needs related to psychosocial aspects of care.
Methods
This qualitative study used an Interpretive Description approach. Seven physiotherapists registered in New Zealand (NZ) who worked with individuals living with SCI were recruited through written and verbal advertisements. In semi-structured, audio-recorded interviews lasting approximately one hour participants explored their understandings of psychosocial adjustment, experiences of integrating psychosocially informed practice into rehabilitation, and the challenges and opportunities associated with this work. Interviews were transcribed, summarised, and returned to participants for review and feedback. Data were analysed using reflexive thematic analysis to generate practice-relevant interpretations. The influence of the researcher’s clinical expertise was examined in a pre-assumptions interview, reflexive journalling, and discussion with supervisors.
Results
Four interconnected themes were identified regarding how physiotherapists support psychosocial adjustment following SCI. Participants described psychosocially informed practice as beginning with self-awareness and self-management, including recognising the limits of their knowledge, managing emotions, and taking responsibility for ongoing learning. They emphasised the importance of building trusting therapeutic relationships through empathy, attunement, and connection. Physiotherapists also described balancing competing tensions within practice, including managing hopes and expectations, adapting to contextual circumstances, integrating physical and psychosocial needs, and making referral decisions. Finally, participants enacted psychosocial support by providing information, facilitating rehabilitation, and connecting individuals with relevant community resources. Collectively, these findings suggest that psychosocially informed practice extends beyond specific techniques and involves a dynamic interplay between self-awareness, relational engagement, and clinical actions.
Discussion
The findings suggest that psychosocially informed physiotherapy practice within SCI rehabilitation is not defined solely by discrete strategies, but by how physiotherapists relate, reflect, and respond within complex rehabilitation contexts. Supporting psychosocial adjustment involved ongoing negotiation of professional roles and attention to the relational and contextual dimensions of care. This study extends a literature largely centred on musculoskeletal and pain populations by providing a practice-based account of how psychosocial practices are understood and enacted in SCI rehabilitation. The findings highlight the importance of relational, contextual, and reflexive capabilities in supporting adjustment following life-changing injury, and suggest that psychosocially informed practice may be better understood as a core component of physiotherapy rather than an adjunct to physical rehabilitation. These findings also highlight the need for educational and supervisory approaches that support the development of relational and reflexive capabilities alongside technical expertise.