Treatment monitoring as a component of psychologically informed physical therapy: A case series of patients at high risk for persistent low back pain related disability

Beneciuk, Jason M.; Ballengee, Lindsay A; George, Steven Z.

doi:10.1016/j.msksp.2019.03.004

Cited by 7 publications

(4 citation statements)

References 68 publications

(92 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Individuals with high fear and pain catastrophizing demonstrated the largest change in pain at 4 weeks when receiving physical therapy compared to those with low psychological factors [ 62 ]. While treatment was not prescribed across participating clinical sites in the current study, 100% of physical therapists in this study reported modifying treatment for those with elevated pain related psychological factors using psychologically informed principles [ 63 – 65 ], such as motivational interviewing and graded exposure. While speculative, this suggests physical therapists may be equipped, or at least knowledgeable, to successfully managing patients with elevated pain-related psychological factors.…”

Section: Discussionmentioning

confidence: 99%

Pain phenotyping and investigation of outcomes in physical therapy: An exploratory study in patients with low back pain

et al. 2023

Self Cite

View full text Add to dashboard Cite

Phenotypes have been proposed as a method of characterizing subgroups based on biopsychosocial factors to identify responders to analgesic treatments. This study aimed to, first, confirm phenotypes in patients with low back pain receiving physical therapy based on an a priori set of factors used to derive subgroups in other pain populations. Second, an exploratory analysis examined if phenotypes differentiated pain and disability outcomes at four weeks of physical therapy. Fifty-five participants completed psychological questionnaires and pressure pain threshold (PPT). Somatization, anxiety, and depression domains of the Symptom-Checklist-90-Revised, and PPT, were entered into a hierarchical agglomerative cluster analysis with Ward’s method to identify phenotypes. Repeated measures ANOVAs assessed pain ratings and disability by phenotype at four weeks. Three clusters emerged: 1) high emotional distress and pain sensitivity (n = 10), 2) low emotional distress (n = 34), 3) low pain sensitivity (n = 11). As an exploratory study, clusters did not differentiate pain ratings or disability after four weeks of physical therapy (p’s>0.05). However, trends were observed as magnitude of change for pain varied by phenotype. This supports the characterization of homogenous subgroups based on a protocol conducted in the clinical setting with varying effect sizes noted by phenotype for short-term changes in pain. As an exploratory study, future studies should aim to repeat this trial in a larger sample of patients.

show abstract

Section: Discussionmentioning

confidence: 99%

Pain phenotyping and investigation of outcomes in physical therapy: An exploratory study in patients with low back pain

et al. 2023

Self Cite

View full text Add to dashboard Cite

show abstract

“…Numerous therapies have been recommended and studied, including multidisciplinary pain treatment programs, cognitive behavioral therapy, and psychologically informed physical therapy. 2,5,20 A systematic review by Quartana et al 20 concluded that reductions in the helplessness component of pain catastrophizing are associated with improvements in pain intensity and pain-related activity interference and disability, although the specificity of this effect is still questionable. Furthermore, a longitudinal study on patients with chronic pain showed that improvement in patient's depression, pain catastrophizing, and anxiety all resulted in improved pain intensity and pain-related disability independent of analgesic therapy.…”

Section: Discussionmentioning

confidence: 99%

Pain Catastrophizing Scale Associated With Other Patient-Reported Outcome Measures in Plantar Fasciitis and Chronic Ankle Instability Patients

et al. 2022

View full text Add to dashboard Cite

Background: The Pain Catastrophizing Scale (PCS) is a measure of how patients emotionally respond to pain. It is composed of 3 subscales—rumination, magnification, and helplessness—which address intrusive thoughts of pain, expectations of negative outcomes, and inability to cope with pain. Our purpose is to compare baseline PCS scores with other baseline patient-reported outcome measures (PROMs) in patients with plantar fasciitis (PF) or chronic ankle instability (CAI). Methods: We retrospectively reviewed 201 patients who reported at least 1 pretreatment PCS subscore and were diagnosed with PF or CAI between 2015 and 2020 in a single fellowship-trained foot and ankle surgeon’s clinic. Demographics, comorbidities, treatments, other baseline PROMs (i.e., visual analog scale [VAS], Pain Disability Index [PDI], 12-Item Short Form Survey [SF-12], 8-Item Somatic Symptom Scale [SSS-8]), and postoperative outcomes were recorded. Results: The PCS total score and its subscores significantly correlated with the total score and/or subscores of each PROM. Higher PCS total score significantly correlated with worse VAS (P<.001), SF-12 mental (P=.007), PDI total (P<.001), and SSS-8 (P<.001) scores. Only the PCS magnification subscore was significantly greater among patients who did (n=41) undergo surgery (P=.043). Those who had previously undergone foot and/or ankle surgery had significantly higher PCS rumination ( P=.012), magnification ( P=.006), helplessness ( P=.008), and total ( P=.003) scores. Likewise, those with a history of substance abuse also had significantly higher PCS scores ( P=.005; P=.003; P=.006; P=.003). Conclusion: The correlations between PCS scores and other baseline PROMs indicate that strong pain catastrophizers with PF or CAI may be at risk for poor treatment outcomes. PCS scores could be used to help with treatment for such high-risk patients.

show abstract

“…During a patient encounter, providers are tasked with many calculations surrounding diagnosis, prognosis, and individualised treatment strategy (Bullock et al., 2021). Clinicians have a solid foundation in collecting relevant anatomic and physiologic data, but lack training in evidenced‐based psychosocial profiles (Alexanders et al., 2015; Beneciuk et al., 2021; Driver et al., 2017; Sanders et al., 2013). Although its application in rehabilitation settings has been limited, personality psychology has a long history in biomedical and psychological research with significant predictive ability, interventional value, and strong associations with a wide set of domains (John & Robins, 2021; Soto, 2021).…”

Section: Clinical Relevance Of Personality Theorymentioning

confidence: 99%

“…Multiple authors have pointed out the lack of other relevant psychological phenomena such as motivation (Crombez et al., 2012), associative learning (Krypotos et al., 2022; Vlaeyen, 2015), attention‐regulation (Boselie & Vlaeyen, 2017; Crombez et al., 2012), personality (Crofford, 2015; Goubert et al., 2004; Wong et al., 2015), trauma (Afari et al., 2014), and social relationships (Edwards et al., 2016) from the traditional yellow flag framework. Furthermore, the majority of research with yellow flag screening has been conducted in select patient populations (Archer et al., 2015; Beneciuk et al., 2021; Coronado et al., 2020; Leeuw et al., 2007; Van Wyngaarden et al., 2019). When used in more widespread patient populations, the predictive ability of multidimensional yellow flag instruments is low (S. Z. George et al., 2018).…”

Section: Introductionmentioning

confidence: 99%

Beyond yellow flags: The Big‐Five personality traits and psychologically informed musculoskeletal rehabilitation

Williams

Waite

Wyngaarden

et al. 2023

Musculoskeletal Care

View full text Add to dashboard Cite

BackgroundPsychosocial variables are known to play an important role in musculoskeletal pain. Recent efforts incorporating psychological theory into rehabilitative medicine, as part of patient‐centred care or psychologically informed physical therapy, have gained broader acceptance. The fear‐avoidance model is the dominant psychosocial model and has introduced a variety of phenomena which assess psychological distress (i.e., yellow flags). Yellow flags, such as fear, anxiety and catastrophizing, are useful concepts for musculoskeletal providers but reflect a narrow range of psychological responses to pain.ObjectiveClinicians lack a more comprehensive framework to understand psychological profiles of each patient and provide individualised care. This narrative review presents the case for applying personality psychology and the Big‐Five trait model (extraversion, agreeableness, conscientiousness, neuroticism and openness to experience) to musculoskeletal medicine. These traits have strong associations with various health outcomes and provide a robust framework to understand patient emotion, motivation, cognition and behaviour.Key ResultsHigh conscientiousness is associated with positive health outcomes and health promoting behaviours. High neuroticism with low conscientiousness increases the odds of negative health outcomes. Extraversion, agreeableness and openness have less direct effects but have positive correlations with important health behaviours, including active coping, positive affect, rehabilitation compliance, social connection and education level.Clinical ApplicationThe Big‐Five model offers an evidence‐based way for MSK providers to better understand the personality of their patients and how it relates to health. These traits offer the potential for additional prognostic factors, tailored treatments and psychological intervention.

show abstract

Treatment monitoring as a component of psychologically informed physical therapy: A case series of patients at high risk for persistent low back pain related disability

Cited by 7 publications

References 68 publications

Pain phenotyping and investigation of outcomes in physical therapy: An exploratory study in patients with low back pain

Pain phenotyping and investigation of outcomes in physical therapy: An exploratory study in patients with low back pain

Pain Catastrophizing Scale Associated With Other Patient-Reported Outcome Measures in Plantar Fasciitis and Chronic Ankle Instability Patients

Beyond yellow flags: The Big‐Five personality traits and psychologically informed musculoskeletal rehabilitation

Contact Info

Product

Resources

About