Feasibility of the biopsychosocial primary care intervention ‘Back on Track’ for patients with chronic low back pain: a process and effect-evaluation

Abstract

Purpose: Literature shows promising effects for interdisciplinary biopsychosocial rehabilitation programs in patients with chronic low back pain (CLBP). Not every patient needs an interdisciplinary rehabilitation trajectory provided in a secondary care setting. Patients with moderate complex psychosocial complaints might benefit from biopsychosocial interventions offered in primary care under supervision of a physician in rehabilitation medicine (i.e. biopsychosocial integrated care intervention). This study investigated the feasibility and effectiveness of such intervention in patients with CLBP with moderate complex psychosocial complaints. Methods: mixed-method. Patients (aged 18-65 years, low back pain !12 weeks, moderate complex psychosocial complaints) received the intervention (4 individual sessions, 8 group sessions) provided by trained primary care physiotherapists. Physicians in rehabilitation medicine provided one consultation afterwards. Data from patients (n ¼ 18), physicians (n ¼ 4) and physiotherapists (n ¼ 12) were used. Results: Physiotherapists were satisfied with the training. Patient attendance was good for individual sessions, less for groups. Physiotherapists sufficiently delivered the intervention, although recruitment and contextual factors influenced delivery. Patients reported significantly reduced functional disability (Quebec Back Pain Disability Scale) post-treatment (À8.3, 95% CI À13.3 to À2.7) and at 3 months follow-up (À7.6, 95% CI À12.9 to À2.2). Conclusions: A biopsychosocial integrated intervention is feasible and potentially effective in patients with CLBP.

Exposure in Vivo as a Treatment Approach to Target Pain-Related Fear: Theory and New Insights From Research and Clinical Practice

“…87 Also, elements of EXP have been introduced in primary care physical therapy settings. 88,89 Lessons learned concern the need for appropriate training of physical therapists, adequate selection of patients, and recommendation to work within multidisciplinary primary care networks. Because physical therapists are typically trained to provide exercise training, extra education is necessary for providing EXP.…”

“…Such education or training would include learning to identify fearful thoughts and avoidance behavior, to create awareness about their impact on the level of functioning, to address PRF in behavioral experiments, and to apply techniques to optimize inhibitory learning. 88 Patients suitable for EXP in primary care should have considerable awareness about their PRF and its influence on daily-life functioning, and should be motivated to change their behavior. When PRF is excessive or other significant psychological or psychiatric comorbidity is present 90,91 or in the case of relapse, the patient should be referred to tertiary care.…”

How to sustain and improve client centred (matched) care in chronic musculoskeletal pain? Start by changing the way policy makers select and judge the large amount of available data, and get rid of the dogma of stepped care

“…Second, the doctrine of stepped care should be abandoned. There are several great examples of cost-effective risk stratified care [4,5] and emerging evidence for matched care [6]. Stepped care is defined as a more conservative (and cheaper) intervention that should be provided first, and a more complex (and expensive) intervention should be progressed to only when the simpler ones fail.…”

The effectiveness of low-dosed outpatient biopsychosocial interventions compared to active physical interventions on pain and disability in adults with nonspecific chronic low back pain: A protocol for a systematic review with meta-analysis

“…However, MBR in secondary or tertiary care is limited in numbers, not widely available in healthcare settings, is associated with long waiting times, and requires a large number of treatment hours from different healthcare professionals [ 11 , 16 , 17 ]. This leads to a high economic burden on individuals and the health system [ 18 ]. According to habit theory, individuals changing their context are more likely to perform non-habitual behaviour.…”

“…Furthermore, outpatient PCBI could support people in establishing plans to cope with difficult situations, anticipate and practice high-risk situations in the social or physical environment [ 23 ]. Another advantage of PCBI is its possible administration by trained physical therapists [ 18 ]. Therefore, it seems to be an interesting and potentially cost-effective approach, as a physiotherapist session in primary care is more accessible and cheaper than multidisciplinary treatment [ 17 ].…”