Psychologically informed physical therapy for musculoskeletal pain: current approaches, implications, and future directions from recent randomized trials

Coronado, Rogelio A.; Brintz, Carrie; McKernan, Lindsey C.; Master, Hiral; Motzny, Nicole; Silva, Flavio M.; Goyal, Parul; Wegener, Stephen T.; Archer, Kristin R.

doi:10.1097/pr9.0000000000000847

Cited by 61 publications

(56 citation statements)

References 88 publications

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“…A recent review of RCTs of psychologically informed physical therapy revealed short-term improvements in functioning among people with knee pain and low-back pain; results for neck pain were inconclusive (Archer et al, 2018). Altogether, findings suggest that physical therapy informed by CBT-CP and by acceptance-and mindfulness-based approaches may hold promise; however, further evaluation is warranted (Coronado et al, 2020).…”

Section: Nonpsychological Treatments With a Psychological Basismentioning

confidence: 99%

Psychological Interventions for the Treatment of Chronic Pain in Adults

Driscoll

Edwards

Becker

et al. 2021

Psychol Sci Public Interest

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The high prevalence and societal burden of chronic pain, its undertreatment, and disparities in its management have contributed to the acknowledgment of chronic pain as a serious public-health concern. The concurrent opioid epidemic, and increasing concern about overreliance on opioid therapy despite evidence of limited benefit and serious harms, has heightened attention to this problem. The biopsychosocial model has emerged as the primary conceptual framework for understanding the complex experience of chronic pain and for informing models of care. The prominence of psychological processes as risk and resilience factors in this model has prompted extensive study of psychological treatments designed to alter processes that underlie or significantly contribute to pain, distress, or disability among adults with chronic pain. Cognitive-behavioral therapy is acknowledged to have strong evidence of effectiveness; other psychological approaches, including acceptance and commitment therapy, mindfulness, biofeedback, hypnosis, and emotional-awareness and expression therapy, have also garnered varying degrees of evidence across multiple pain conditions. Mechanistic studies have identified multiple pathways by which these treatments may reduce the intensity and impact of pain. Despite the growing evidence for and appreciation of these approaches, several barriers limit their uptake at the level of organizations, providers, and patients. Innovative methods for delivering psychological interventions and other research, practice, and policy initiatives hold promise for overcoming these barriers. Additional scientific knowledge and practice gaps remain to be addressed to optimize the reach and effectiveness of these interventions, including tailoring to address individual differences, concurrently addressing co-occurring disorders, and incorporating other optimization strategies.

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Section: Nonpsychological Treatments With a Psychological Basismentioning

confidence: 99%

Psychological Interventions for the Treatment of Chronic Pain in Adults

Driscoll

Edwards

Becker

et al. 2021

Psychol Sci Public Interest

View full text Add to dashboard Cite

show abstract

“…18 Two years later, Coronado et al identified 18 randomized controlled trials (n = 2387) that used PIPT approaches for patients with musculoskeletal pain and found that PiP interventions had a greater effect on reduction of disability and pain than education or exercise-only interventions. 17,19 A notable observation for this evidence base is that explanatory clinical trials investigating PIPT for low back pain have a tendency to show favorable results; however, pragmatic trials have shown less promising outcomes. For example, the TARGET trial (77 primary care clinics, n = 2300 enrolled patients) investigated whether a riskstratified approach would result in lower rates of chronic low back pain and improved self-reported disability.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Ballengee¹,

Zullig²,

George³

2021

JPR

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Low back pain continues to be a leading cause of disability and cost throughout the world. Evidence-based guidelines recommend use of non-pharmacological interventions to address decreases in physical function due to low back pain. Psychologically informed physical therapy (PIPT) is one way to effectively and efficiently address the need for nonpharmacological approaches. However, adoption of psychologically informed practice (PiP) by physical therapists has shown mixed results due to implementation challenges. In this perspective, we discuss the current state of PIPT training and implementation. We also propose a conceptual roadmap for future implementation needs related to increasing delivery of PIPT-informed approaches.

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“…In chronic conditions, such as back pain, complex interventions that use a biopsychosocial framework are encouraged [ 1 – 5 ]. However, applying this holistic multimodal approach in physical therapy practice is challenging and has not been extensively investigated to guide clinicians.…”

Section: Introductionmentioning

confidence: 99%

A process evaluation of the Mind Your Back trial examining psychologically informed physical treatments for chronic low back pain

2021

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Background In chronic conditions, such as back pain, the use of interventions that address physical, social and psychological aspects within a biopsychosocial framework are encouraged, however, applying this holistic multimodal approach in physical therapy practice (i.e., chiropractic and physiotherapy) is challenging. To explore the problem of delivering a biopsychosocially informed package of care in physical therapy practice a recent randomised control trial (RCT) called ‘Mind Your Back’ was conducted to evaluate the effectiveness of a combined physical and internet-delivered psychological intervention (psychologically informed physical treatments) compared to standard treatment for improving disability and self-efficacy in people with chronic LBP. The results of the trial indicated no difference between the two intervention groups. Although high-quality RCTs are considered gold standard for effectiveness of interventions, qualitative research methods embedded within a process evaluation framework are also used to reveal other issues and important information that help to explain clinical trial results, and to further the field of digital health interventions research. Therefore, within a process evaluation framework, the aim is to explore participants experiences of the interventions received throughout the Mind Your Back trial which led to a null result. Methods In-line with recommendations for a process evaluation this study used in-depth interviews and qualitative thematic analysis with participants of both arms of the trial 5–6 months after study completion. Semi-structured telephone interviews were conducted with twenty-five participants to explore their experiences of taking part in the Mind Your Back trial. Interviews were conducted in November 2017, transcribed verbatim and data analysed thematically. Results Two main themes were identified: (1) Personalised support and therapeutic alliance are important, and (2) MoodGYM lacked relevant, personalised and tailored support. Conclusion It is important to deliver tailored digital health supports that is personalised and fosters a therapeutic alliance.

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Psychologically informed physical therapy for musculoskeletal pain: current approaches, implications, and future directions from recent randomized trials

Cited by 61 publications

References 88 publications

Psychological Interventions for the Treatment of Chronic Pain in Adults

Psychological Interventions for the Treatment of Chronic Pain in Adults

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

A process evaluation of the Mind Your Back trial examining psychologically informed physical treatments for chronic low back pain

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