TY - JOUR
T1 - Physical Therapy Informed by Acceptance and Commitment Therapy (PACT) Versus Usual Care Physical Therapy for Adults With Chronic Low Back Pain
T2 - A Randomized Controlled Trial
AU - Godfrey, Emma
AU - Wileman, Vari
AU - Galea Holmes, Melissa
AU - McCracken, Lance M.
AU - Norton, Sam
AU - Moss-Morris, Rona
AU - Noonan, Sandra
AU - Barcellona, Massimo
AU - Critchley, Duncan
PY - 2020/1/1
Y1 - 2020/1/1
N2 - Chronic low back pain (CLBP) is a major cause of global disability and improving management is essential. Acceptance and commitment therapy (ACT) is a promising treatment for chronic pain but has not been modified for physical therapy. This randomized controlled trial (RCT) compared physical therapy informed by ACT (PACT) against standard care physical therapy for patients with CLBP. Patients with CLBP (duration ≥12 weeks, mean 3 years) were recruited from physical therapy clinics in 4 UK public hospitals. The Roland-Morris Disability Questionnaire (RMDQ) at 3 months’ post-randomization was the primary outcome. Two hundred forty-eight participants (59% female, mean age = 48) were recruited and 219 (88.3%) completed measures at 3 and/or 12 months’ follow-up. At 3 months, PACT participants reported better outcomes for disability (RMDQ mean difference = 1.07, p =.037, 95% CI = −2.08 to −.07, d =.2), Patient Specific Functioning (p =.008), SF12 physical health (p =.032), and treatment credibility (p <.001). At 12 months’ follow-up, there were no significant differences between groups. PACT was acceptable to patients and clinicians and feasible to deliver. Physical therapists incorporated psychological principles successfully and treatment was delivered with high (≥80%) fidelity. Our results may inform the management of CLBP, with potential benefits for patients, health care providers, and society. Perspective: Psychologically informed physical therapy has great potential but there are challenges in implementation. The training and support included in the PACT trial enabled the intervention to be delivered as planned. This successfully reduced disability in the short but not long term. Findings could inform physical therapists’ treatment of CLBP.
AB - Chronic low back pain (CLBP) is a major cause of global disability and improving management is essential. Acceptance and commitment therapy (ACT) is a promising treatment for chronic pain but has not been modified for physical therapy. This randomized controlled trial (RCT) compared physical therapy informed by ACT (PACT) against standard care physical therapy for patients with CLBP. Patients with CLBP (duration ≥12 weeks, mean 3 years) were recruited from physical therapy clinics in 4 UK public hospitals. The Roland-Morris Disability Questionnaire (RMDQ) at 3 months’ post-randomization was the primary outcome. Two hundred forty-eight participants (59% female, mean age = 48) were recruited and 219 (88.3%) completed measures at 3 and/or 12 months’ follow-up. At 3 months, PACT participants reported better outcomes for disability (RMDQ mean difference = 1.07, p =.037, 95% CI = −2.08 to −.07, d =.2), Patient Specific Functioning (p =.008), SF12 physical health (p =.032), and treatment credibility (p <.001). At 12 months’ follow-up, there were no significant differences between groups. PACT was acceptable to patients and clinicians and feasible to deliver. Physical therapists incorporated psychological principles successfully and treatment was delivered with high (≥80%) fidelity. Our results may inform the management of CLBP, with potential benefits for patients, health care providers, and society. Perspective: Psychologically informed physical therapy has great potential but there are challenges in implementation. The training and support included in the PACT trial enabled the intervention to be delivered as planned. This successfully reduced disability in the short but not long term. Findings could inform physical therapists’ treatment of CLBP.
KW - acceptance and commitment therapy
KW - Chronic low back pain
KW - physical therapy
KW - randomized controlled trial
UR - http://www.scopus.com/inward/record.url?scp=85068956844&partnerID=8YFLogxK
U2 - 10.1016/j.jpain.2019.05.012
DO - 10.1016/j.jpain.2019.05.012
M3 - Article
C2 - 31173921
AN - SCOPUS:85068956844
SN - 1526-5900
VL - 21
SP - 71
EP - 81
JO - JOURNAL OF PAIN
JF - JOURNAL OF PAIN
IS - 1-2
ER -