Implementation of Psychologically Informed Physical Therapy for Low Back Pain: Where Do We Stand, Where Do We Go?

Ballengee, Lindsay A; Zullig, Leah L.; George, Steven Z.

doi:10.2147/jpr.s311973

Cited by 23 publications

(21 citation statements)

References 51 publications

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“…Widespread implementation of such an approach will be a challenge. 1 The secondary aim of this trial was to determine if there was a differential effect of risk ("low risk or medium/high" risk) on outcomes. Although we found no risk 3 treatment 3 time interaction, these results should be interpreted with caution.…”

Section: Discussionmentioning

confidence: 99%

Implementation of a risk-stratified, guideline-based clinical pathway of care to improve health outcomes following whiplash injury (Whiplash ImPaCT): a multicentre, randomized, controlled trial

Rebbeck,

Bandong,

Leaver

et al. 2023

Pain

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Current pathways of care for whiplash follow a “stepped care model,” result in modest treatment outcomes and fail to offer efficient management solutions. This study aimed to evaluate the effectiveness of a risk-stratified clinical pathway of care (CPC) compared with usual care (UC) in people with acute whiplash. We conducted a multicentre, 2-arm, parallel, randomised, controlled trial in primary care in Australia. Participants with acute whiplash (n = 216) were stratified for risk of a poor outcome (low vs medium/high risk) and randomised using concealed allocation to either the CPC or UC. In the CPC group, low-risk participants received guideline-based advice and exercise supported by an online resource, and medium-risk/high-risk participants were referred to a whiplash specialist who assessed modifiable risk factors and then determined further care. The UC group received care from their primary healthcare provider who had no knowledge of risk status. Primary outcomes were neck disability index (NDI) and Global Rating of Change (GRC) at 3 months. Analysis blinded to group used intention-to-treat and linear mixed models. There was no difference between the groups for the NDI (mean difference [MD] [95% confidence interval (CI)] −2.34 [−7.44 to 2.76]) or GRC (MD 95% CI 0.08 [−0.55 to 0.70]) at 3 months. Baseline risk category did not modify the effect of treatment. No adverse events were reported. Risk-stratified care for acute whiplash did not improve patient outcomes, and implementation of this CPC in its current form is not recommended.

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Section: Discussionmentioning

confidence: 99%

Implementation of a risk-stratified, guideline-based clinical pathway of care to improve health outcomes following whiplash injury (Whiplash ImPaCT): a multicentre, randomized, controlled trial

Rebbeck,

Bandong,

Leaver

et al. 2023

Pain

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“…Results from our sensitivity analyses assessing PAPD domains suggest that clinicians may consider tailoring psychologically informed strategies based on the patient's pain‐related psychological profile to address baseline pain intensity and patient expectations of treatment effectiveness in patients with neck and low back pain and hip/knee OA 13 . Clinicians may also consider this approach to improve physical function in patients with low back pain 13,76 . Based on the small effects in this study, clinicians should view PAPD within the broader context of the full patient experience, as there are many factors associated with baseline pain intensity, patient expectations, and physical function at discharge.…”

Section: Discussionmentioning

confidence: 99%

“…13 Clinicians may also consider this approach to improve physical function in patients with low back pain. 13,76 Based on the small effects in this study, clinicians should view PAPD within the broader context of the full patient experience, as there are many factors associated with baseline pain intensity, patient expectations, and physical function at discharge.…”

Section: Clinical Relevancementioning

confidence: 99%

The relationships between pain‐associated psychological distress, pain intensity, patient expectations, and physical function in individuals with musculoskeletal pain: A retrospective cohort study

Leech

Lulofs-MacPherson

Klopper

et al. 2023

PM&R

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IntroductionThe presence of pain‐associated psychological distress (PAPD) in musculoskeletal disorders, including negative mood, fear‐avoidance, and lack of positive affect/coping, is associated with prolonged disability. The importance of considering psychological influence on pain is well known, but practical ways of addressing it are not as straightforward. Identifying relationships between PAPD and pain intensity, patient expectations, and physical function may guide the development of future studies that assess causality and inform clinical practice.ObjectiveTo assess the relationship between PAPD measured by the Optimal Screening for Prediction of Referral and Outcome—Yellow Flag tool, and baseline pain intensity, expectations of treatment effectiveness, and self‐reported physical function at discharge.DesignRetrospective cohort study.SettingHospital‐based outpatient physical therapy.ParticipantsPatients 18 to 90 years old with spinal pain or lower extremity osteoarthritis.Main Outcome MeasuresPain intensity and patient expectations of treatment effectiveness at intake, and self‐reported physical function at discharge.ResultsA total of 534 patients, 56.2% female, median (interquartile range [IQR]) age 61 (21) years with an episode of care between November 2019 and January 2021 were included. A multiple linear regression showed a significant association between PAPD and pain intensity with 6.4% (p < .001) of the variance explained. PAPD explained 3.3% (p < .001) of the variance in patient expectations. One additional yellow flag present resulted in a 0.17‐point increase in pain intensity and 1.3% decrease in patient expectations. PAPD was also associated with physical function with 3.2% (p < .001) of the variance explained. PAPD explained 9.1% (p < .001) of the variance in physical function at discharge in the low back pain cohort only when assessed independently by body region.ConclusionThese findings support the theory that the pain experience is complex and multiple factors should be considered when evaluating a patient with musculoskeletal pain. Clinicians who have identified PAPD may consider these relationships when planning or modifying interventions and pursuing multidisciplinary collaboration.

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“…For others, this trial may spur an emphasis on clinical trials that directly consider implementation outcomes for risk-stratified care as precursors to testing effectiveness (eg, hybrid trial designs). 1 Those in the latter camp will consider the 2022 IASP Global Year of Pain Focus— translating pain knowledge to practice —still highly relevant into 2023 and beyond. 7…”

Section: What Does This Say About Risk-stratified Care?mentioning

confidence: 99%

Lost in implementation: risk stratified care for musculoskeletal pain

George

2023

Pain

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Implementation of Psychologically Informed Physical Therapy for Low Back Pain: Where Do We Stand, Where Do We Go?

Cited by 23 publications

References 51 publications

Implementation of a risk-stratified, guideline-based clinical pathway of care to improve health outcomes following whiplash injury (Whiplash ImPaCT): a multicentre, randomized, controlled trial

Implementation of a risk-stratified, guideline-based clinical pathway of care to improve health outcomes following whiplash injury (Whiplash ImPaCT): a multicentre, randomized, controlled trial

The relationships between pain‐associated psychological distress, pain intensity, patient expectations, and physical function in individuals with musculoskeletal pain: A retrospective cohort study

Lost in implementation: risk stratified care for musculoskeletal pain

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