What clinician skills do you believe are most critical for delivering very high-quality care for people with back pain? 

In my opinion, delivering high-quality care for people with low back pain requires clinicians to have a range of different skills and to know when to use each. 

However, two of the most critical skills include high-level clinical reasoning to identify the most important treatment targets for each individual patient, and outstanding communication skills to help patients understand their problem from a biopsychosocial framework—consistent with a modern understanding of back pain. 

Excellent communication is especially important in back pain where providing patients with an anatomical diagnosis is usually not possible and not helpful in directing care. 

It is critical the patient feels the clinician has a deep understanding of their problem and a clear shared plan of treatment. 

What aspects of the training of clinicians for the RESTORE trial do you believe were most important to the long-term effects? 

Some of the key aspects of clinician training which we believe contributed to the long-term effects include: 

• The clinicians were encouraged to take on the role of a coach rather than a fixer, and to empower patients to self-manage their condition. This required clinicians to help patients understand their condition and develop strong self-efficacy.
• The clinicians were trained to directly address the near certainty of future recurrences or flare-ups with patients. This was discussed during all sessions, but it was a particular focus in the six-month follow-up session that occurred even if patients were doing well and had no current pain.
• All clinicians treated several real patients in front of their colleagues and the trainers. This provided them with feedback that we almost never get as clinicians. The clinicians described this as critical to their skill development. 

Mark Hancock will be talking about the RESTORE trial in his APASC2025 keynote.

Do universities have a role in teaching advanced skill? 

Absolutely. I strongly believe that the early training is critical to later development of advanced skills. 

Most advanced skills involve doing the basics really well. 

Our experience with training clinicians, has been that those with really strong entry-level training and some exposure to advanced skills during their entry level training are able to develop advanced skills easily when they later have more experience and some additional training or mentoring. 

>>Mark Hancock is Professor of Physiotherapy and co-director of the Spinal Pain Research Centre at Macquarie University. He has over 20 years of clinical experience as a musculoskeletal physiotherapist. His research focuses on the diagnosis, prevention and treatment of low back pain. 

>>Mark is presenting the keynote ‘What is required for advanced physiotherapy care of back pain, now and in the future?’ on Thursday 23 October at 11:05 am and is also a presenter for the Advanced Practice/Musculoskeletal pre-conference half-day workshop ‘An evidence-based approach to the role of spinal imaging in contemporary musculoskeletal practice’ on Wednesday 22 October at 8:30 am.

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