Psychosocial Treatment Techniques to Augment the Impact of Physiotherapy Interventions for Low Back Pain

Abstract

Purpose: The present study examined the profile of physical and psychosocial changes that occur in physiotherapy intervention when patients also participate in a psychosocial intervention. The psychosocial intervention, delivered by physiotherapists, was designed to target catastrophic thinking, fear of pain, perceived disability, and depression. Methods: The study sample consisted of 48 individuals referred for the rehabilitation treatment of disabling back pain. Half the sample was enrolled in a physiotherapy intervention only; the other half was enrolled in a psychosocial intervention in addition to receiving a physiotherapy intervention. Results: At post-treatment, the two treatment groups did not differ significantly on measures of pain severity, physical function, or self-reported disability. Patients who participated in the psychosocial intervention in addition to physiotherapy showed significantly greater reductions in pain catastrophizing, fear of movement, and depression than patients who received only the physiotherapy intervention. Reductions in psychosocial risk factors contributed to reduced use of the health care system, reduced use of pain medication, and improved return-to-work outcomes. Conclusions: The findings of the present study suggest that a psychosocial intervention provided by physiotherapists can lead to meaningful reductions in psychosocial risk factors for pain and disability and may contribute to more positive rehabilitation outcomes.Key Words: catastrophizing, fear of pain, musculoskeletal pain, psychosocial factors, rehabilitation, return to work Sullivan MJL, Adams H. Psychosocial treatment techniques to augment the impact of physiotherapy interventions for low back pain. Physiother Can. 2010;62:180-189. RÉ SUMÉObjectif : La pré sente é tude examine le profil des changements physiques et psychologiques qui surviennent lors d'interventions en physiothé rapie chez les patients qui participent é galement à une intervention psychosociale. L'intervention psychosociale, assuré e par des physiothé rapeutes, a comme objectif de cibler la pensé e catastrophique, la peur de la douleur, l'incapacité perc¸ue et la dé pression. Mé thode : L'é chantillon é tudié se composait de 48 personnes envoyé es pour des traitements de ré adaptation pour des maux de dos incapacitants. La moitié des personnes participaient aussi à une intervention psychosociale en plus de recevoir des soins en physiothé rapie. Ré sultats : En post-traitement, les deux groupes traité s n'affichaient pas de grandes diffé rences en ce qui a trait aux mesures d'intensité de la douleur, à la fonction physique ou à l'incapacité signalé e par le sujet. La tendance à ne voir que la douleur, la peur de bouger et la dé pression ont toutefois é té grandement ré duites chez les patients qui prenaient part à une intervention psychosociale en plus de recevoir leurs soins en physiothé rapie. Ces ré ductions des facteurs de risque psychosociaux ont contribué à ré duire l'utilisation des soins de santé et des mé dicaments contre la...

Recovery From Depressive Symptoms Over the Course of Physical Therapy: A Prospective Cohort Study of Individuals With Work-Related Orthopaedic Injuries and Symptoms of Depression

“…2,55,59 Previous research also suggests that physical therapists can effectively use these interventions to help improve their patients' outcomes. 27,40,54 Although there has yet to be any physical therapy research that has specifically evaluated the impact of such psychosocial interventions on a sample of patients with depressive symptoms, results from a recent study by Sullivan and Adams 54 suggest their benefit. This study showed that when physical therapists added a psychosocial dimension to their traditional treatment, their patients experienced, on average, an additional 51% reduction in their symptoms of depression.…”

“…Moreover, results from previous studies suggest that, for some patients, symptoms of depression can improve over the course of physical therapy treatment. 51,54 Thus, referral of patients whose symptoms would have resolved without the intervention of a mental health expert may prove to be an inefficient use of resources. Without additional research exploring the management of patients with depressive symptoms, physical therapists may be at a loss to decide when to proceed with treatment as usual or when additional interventions are warranted.…”

Attitudes and beliefs of Brazilian physical therapists about chronic low back pain: a cross-sectional study

“…Another possible explanation is that these previous studies were conducted in European countries, where most biopsychosocial theories/treatments have been developed and where the incorporation of the biopsychosocial model is stronger among healthcare providers 34 (e.g., cognitivebehavioral principles are fully integrated into physical therapy management of patients with low back pain [34][35][36][37] ).…”

A telephonic intervention for promoting occupational re-integration in work-disabled individuals with musculoskeletal pain

“…The approach used in PGAP-Tel (and PGAP) to reduce catastrophizing includes education, the use of disclosure and validation techniques, thought monitoring/re-appraisal, goal setting, and activity participation. In previous research, these techniques have been shown to be effective in reducing catastrophic thinking [33,36,43]. It is not clear why these techniques are less effective when used telephonically as opposed to face-toface.…”