Feasibility and acceptability of telephone‐delivered cognitive‐behavioral‐based physical therapy for patients with traumatic lower extremity injury

Abstract

Purpose To determine feasibility and acceptability of a telephone‐based Cognitive‐Behavioral‐Based Physical Therapy program for patients following traumatic lower extremity injury (CBPT‐Trauma). Methods Patients were screened for high psychosocial risk factors and then completed the 6‐week CBPT‐Trauma program. Physical function, pain, and psychosocial outcomes were assessed at baseline and 6‐months follow‐up. Descriptive statistics assessed change in outcomes. Results Recruitment rate was 59%. Twenty‐seven patients (73%) had a high psychosocial risk profile. Twelve patients completed the program and the follow‐up assessment at 6 months and found the program to be very or extremely helpful to their overall recovery. All demonstrated a clinically meaningful increase in physical function. Six patients demonstrated a clinically relevant decrease in pain intensity, pain catastrophizing, and fear of movement. Seven patients reported a clinically meaningful increase in pain self‐efficacy. Discussion Findings suggest that recruitment is feasible for CBPT‐Trauma program. However, engagement in the CBPT‐Trauma study was low. For those that completed the program, patients were satisfied with the CBPT‐Trauma program and experienced meaningful improvement in psychosocial factors and patient‐reported outcomes. This open pilot study highlights the importance of targeted treatment for patients at high‐risk for poor outcomes and the potential for increased access to services through telephone‐delivery.

Cognitive-Behavioral–Based Physical Therapy for Improving Recovery After Traumatic Orthopaedic Lower Extremity Injury (CBPT-Trauma)

“…This trial builds off previous pilot testing of the CBPT-Trauma program, which found the program to be feasible in recruitment and screening rates and acceptable based on patient satisfaction and improvements in patientreported physical function. 17 Early testing of the CBPT-Trauma program supports screening and a targeted approach to care, which is consistent with previous studies of psychosocial interventions in the trauma population. 13,47,48 Overall, our interventional approach (CBPT-Trauma) is designed to empower patients to return to a productive life both inside and outside the home and ultimately improve their general physical and mental health.…”

“…The duration of the programs and each session was established during proof-of-concept and pilot test work and has been found to be acceptable to patients and effective for clinically meaningful treatment effects. 17,25 At 5 and 9 months post-initial hospital discharge, booster sessions were conducted with both groups. During the booster sessions, the CBPT-Trauma participants reviewed their recovery plan and discussed utilization of their self-management strategies and the education participants had a general check-in call to review the educational material.…”

“…25 The program was adapted for trauma survivors (CBPT-Trauma) by including more emphasis on cognitive-restructuring and mindfulness strategies, functional strengthening exercises, and education on physical and mental recovery after traumatic injury. 17 Two booster sessions were added to reinforce adherence to the recovery plan that was created with the patient during the intervention phase. Overall, the CBPT-Trauma program focuses on a patient-oriented cognitive-behavioral self-management approach to improve physical function and reduce pain through increases in pain self-efficacy and reductions in fear of movement and pain catastrophizing.…”

“…15,16 The current study evaluates the efficacy of a telephonedelivered cognitive-behavioral-based physical therapy (CBPT-Trauma) program previously implemented through an open pilot study in patients after traumatic lower extremity injury who were screened for high psychosocial risk factors. 17 Patients in the pilot study found the CBPT-Trauma program feasible and acceptable, and meaningful improvements were observed in patient-reported psychosocial and physical function outcomes. The specific aims of the current study are to (1) determine the efficacy of the CBPT-Trauma program for improvement in the prespecified clinical end points among patients at-risk for poor outcomes after traumatic lower extremity injury; (2) determine whether changes in pain self-efficacy, fear of movement, and pain catastrophizing at 6 months are associated with improvement in outcomes at 12 months after hospital discharge; (3) determine whether subgroups of patients are more likely to benefit from the CBPT-Trauma program; and (4) examine the value of CBPT-Trauma relative to an education program, using the Markov decision analysis.…”

Cognitive-Behavioral-Based Physical Therapy for Improving Recovery After a Traumatic Lower-Extremity Injury

“…Two licensed physical therapists with >10 years of experience treating patients with musculoskeletal pain delivered the programs remotely by telephone to all patients in the treatment group. The CBPT for trauma survivors (CBPT-Trauma) intervention in this study was adapted from CBT-based programs for chronic pain and spine surgery [23][24][25][26][27][28][29][39][40][41] by emphasizing a patient-oriented cognitive-behavioral self-management approach to decrease pain and increase physical function 23 . The education control program consisted of the provision and discussion of written education materials typically provided by the physical therapy care team during postoperative recovery as well as scheduled interactions with a physical therapist, during which these materials were reviewed 35 .…”