Remotely Delivered Psychologically Informed Mindful Movement Physical Therapy for Pain Care: A Framework for Operationalization

Abstract

Background While there is recognition by the greater medical community and physical therapists to address the biopsychosocial needs of people with chronic, persistent pain, there are challenges in implementation and delivery including wide variability in interventions, lack of clear rationale, and absence of clinical models that are feasible and acceptable on a large scale. Important components for psychologically informed physical therapy (PiPT) for pain care include behavioral approaches (e.g., Acceptance and Commitment Therapy), mindfulness, pain neuroscience education, motivational interviewing (MI), and interoceptive skills-building. The Empower Veterans Program (EVP) Mindful Movement framework blends these components and emphasizes a mindfulness and self-compassion approach with MI and body-based experiential learning. This program was offered in-person at the Atlanta and Maryland VA Health Care Centers with published positive Patient Reported Outcomes (PRO) pre-COVID 19 crisis and shifted to entirely remote delivery in March 2020. Objective This paper offers an evidence-based and theory driven framework to operationalize a remotely delivered group-based psychologically informed mindful movement physical therapy intervention as part of an interdisciplinary pain care program. Methods Since 2021 PRO and demographics are collected using a survey administered through Qualtrics over a 12-month period at baseline, immediately post TelePain EVP, at 6 months, and at 12 months, with findings forthcoming. Discussion/Results Tele-pain EVP offers 6-9 groups a week with 7-9 veterans from Atlanta based team and 3-4 groups a week with 5-9 veterans from Maryland based team. Adaptations for remote delivery optimized mindfulness and active learning strategies including interoceptive skills-building and use of MI to support self-efficacy to trust, restore a sense of safety in the body, and explore adaptations for safe movement. Conclusion TelePain-EVP Mindful Movement provides a framework for other programs to translate for their populations and systems to further develop best practices in PiPT for pain care and integration into interdisciplinary care.

Benchmark findings from a veteran electronic patient-reported outcomes evaluation from a chronic pain management telehealth program

“…TelePain-EVP is an evidence-based program delivered in a weekly format over 10 consecutive weeks [ 36 , 37 , 39 , 40 , 43 ]. Each week, veteran cohorts ( n = 4 to 20) engage in three one-hour evidence-informed group therapy sessions facilitated by an integrated interdisciplinary team of professionals (ACT – psychologists/social workers, MM – physical therapists, WH – chaplains).…”

“…The Empower Veterans Program (EVP) is a non-pharmacological interdisciplinary chronic pain rehabilitation program that integrates ACT, its core behavioral therapy, with mindful movement (MM), and whole health (WH) [ 36 ]. MM within EVP teaches veterans to observe and accept mind–body experiences while emphasizing an open, nonjudgmental attitude [ 37 ]. The focus is to change their relationship between unpleasant thoughts, emotions, and body sensations than can influence pain (e.g., willing engagement in previously avoided movements due to reduced fear or sense of threat).…”

Remote Delivery of Mindful Movement Within Healthcare Systems: Lessons Learned From the Veterans Health Administration

“…The mindful movement class is led by physical therapists who are also yoga teachers and integrates an experiential body-based learning of the topics in the other 2 classes with pain neuroscience education and interoceptive skills-building. 14 For example, participants explore their own personal values throughout the program and the mindful movement classes focus on how the experience of connecting to one’s values affects the body (muscle tension, breath, quality of movement) and can set the stage for safe movement. The mindful awareness and self-compassion taught in the other 2 classes also become the lens through which movement is explored and “tried on” to find safer ways to move.…”