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Table 2 Themes, subthemes and examples of quotes from qualitative interviews

From: Physiotherapists perceived role in managing anxiety in patients with relapsing-remitting multiple sclerosis: a mixed-methods study

Theme 1: Understanding the MS Journey
Subtheme: Physiotherapist Role
“It’s being able to know when it’s not actually for you and you need to hand it over” (PT1)
“I guess for neuro there’s that really good understanding of the acceptance journey that people go on. Because that’s when we see anxiety come out, that’s when we see depression come out, that’s when we see anger and frustration and those, and probably that difference between what’s “normal” anxiety and depression and moving on that journey of grief and acceptance and what’s dysfunctional and potentially dangerous” (PT5)
Subtheme: Patient’s expectations
“I think MS patients’ expectation of physio in general is quite high because they see physio as the thing that’s going to get them better because there isn’t a wonder drug. With MS it isn’t like that, they, they hang everything on their physio.” (PT2)
“We have some people who come expecting somebody to do something to them … and convincing people to continue exercises, or other interventions anyway, when they’re not here can be quite difficult” (PT3)
Theme 2: Modifying assessment and treatment
Subtheme: Impact of anxiety
“I think the anxiety, if people have that when they come in for whatever reason, that can really sort of inhibit how much they take on.” (PT3)
“How good are we at you know, having our own strategies to work with that population, remain positive and not get to that point of burn out or, stress or, beating yourself up because you think you haven’t delivered a good session” (PT5)
Subtheme: Management strategies
“I’m not sure that the GP would always be the best person to help deal with [anxiety], but they might have access to local services to help that patient … the MS nurses are really good sources of information and support for patients.” (PT3)
“I think that signposting to the more psychological therapies, I think we have to be really knowledgeable about those things.” (PT5)
Theme 3: Anxiety management toolbox
Subtheme: Skills and attributes
“I think you can alleviate somebody’s worry just by talking to them.” (PT2)
“I think the ability to empathise and to listen and to give a degree of understanding and gain a rapport, its all, it’s all involved in being able to effectively communicate both verbally and non-verbally I guess” (PT4)
Subtheme: Barriers and facilitators
“its lack of confidence and feeling like they haven’t got the tools in their tool kit to be able to give the appropriate advice to people.” (PT2)
“I think if you were going into it and you were newly qualified, I think you wouldn’t want to be delving into that area because you probably don’t have that experience to go off” (PT4)
“Perhaps there’s something about us looking in, I talked about supervision. If you look at psychology, social work or OT*, they’re really good at addressing their own wellbeing within supervision.” (PT5)
Theme 4: Lagging behind MSK*
“They’re getting better at that in MSK than we possibly are in neuro … Pete O’Sullivan people like that are doing courses where you’re listening to the patient’s story and what that is actually telling you about how that’s impacting them, and I think that’s really important” (PT2)
“If you look within chronic pain there is evidence that psycho-education changes people’s physical symptoms or experience of pain. If we can do that in chronic pain, we can do that in every condition.” (PT5)
Theme 5: Gaining knowledge and skills
Subtheme: Interprofessional working
“I’m sure that the MS nurses will do absolutely loads of psychological support, because you know in their role, so actually there’s probably a lot that we could learn and a lot that we could share between us.” (PT1)
“Learning from psychology, I’ve learned heaps from working with psychologists” (PT5)
Subtheme: Physiotherapy training
“At an undergrad level it needs much more emphasis, about we need to look at the whole person and looking at the evidence now that supports how the psychological impact of things affects physical symptoms, we’re no longer just treating physical symptoms were treating the whole patient.” (PT2)
“more of a guidance package than a training package sort of you know … coming sort of centrally as part of CSP*, guidance or case studies for example on iCSP” (PT3)
  1. *CSP Chartered Society of Physiotherapy *MSK Musculoskeletal *OT Occupational Therapy