Trauma—or stressful, frightening and distressing events—affects about three-quarters of Australians and can have a significant, wide-ranging and lasting impact on both relationships and health.

Trauma-informed healthcare is a holistic approach that does not specifically treat trauma but instead increases awareness and understanding between clinician and patient by following the core principles of safety, trust, choice, collaboration and empowerment.

While trauma-informed principles have been embraced in many areas of healthcare, it’s not an area in which physiotherapists are specifically trained, says Dr Sophie Heywood MACP, the Clinical Research Coordinator for the Department of Physiotherapy at St Vincent’s Hospital Melbourne.

‘Trauma-informed care isn’t about treating people’s trauma or talking to people about their trauma; it’s about recognising how people might feel in healthcare settings and understanding how to support them and keep them engaged,’ she says.

‘Physios are already good at this.

'They’re good at active listening and making people feel like individuals; they’re good at goal setting, collaborating and building skills, especially physical skills.

'But there are elements of trauma-informed care—particularly related to psychological safety— that physios are still trying to work out.’

Sophie and her colleagues recently published a study in Physiotherapy Theory and Practice (here), mapping physiotherapy practice against the principles of trauma-informed care to find the gaps in knowledge and practice.

‘Sometimes, with the best of intentions, physios have a very clear idea about what they think will work and a strong belief in helping someone move better but that person might not be ready for that information or that push.

'It’s useful for us to think a bit more laterally and with a bit more flexibility about what might be appropriate at any one time,’ she says.

The study has formed the basis of the ‘UPTIC: Upskilling Physiotherapists in Trauma-Informed Care’ project.

Sophie was recently awarded a Pat Cosh Trust Fund Annual Grant to develop and evaluate a training program for physiotherapists covering four key themes—understanding trauma and the impact of trauma; trauma-informed principles including psychological safety and skills to improve patient experience; overcoming barriers to implement trauma-informed care; physiotherapist safety and resilience and strategies for clinician stress management.

Sophie says a major part of the training will focus on being more aware of trauma and the impact for patients but the program will also look at the effect of trauma-informed care on managing vicarious traumatic and compassion fatigue and the practitioner’s own self-care.

‘It’s important to be aware of trauma, to recognise when someone’s feeling uncomfortable in a consultation and to know how to deal with it.

'But it is also really important for physios to know when they’re outside what feels comfortable for them and to make sure that they’re looking after themselves,’ she says.

The proposed program will consist of several modules delivered online, comprising about six hours of learning in total, followed by a workshop (in person or virtual) to help physiotherapists implement their new understanding of trauma-informed care in their practice.

Sophie says the researchers are well underway in designing the modules and have started some preliminary testing of the program, with the assistance of physiotherapists at St Vincent’s Hospital Melbourne.

In the evaluation phase, the team plans to recruit about 60 physiotherapists from metro and regional Victoria to complete the program and provide feedback on acceptability, satisfaction, knowledge and practice change.

Ultimately, Sophie hopes the project will clarify what trauma-informed care principles mean for physiotherapy, both at an individual level and across multidisciplinary teams and healthcare more broadly.

‘We want to develop a feasible and meaningful training package for physios but we also want to have a wider impact on healthcare in relation to trauma-informed principles.

'That’s what we’re hoping to learn about and work towards,’ Sophie says.

COURSE OF INTEREST: Trauma-focused physiotherapy