Cognitive-Behavioral–Based Physical Therapy for Improving Recovery After Traumatic Orthopaedic Lower Extremity Injury (CBPT-Trauma)

Abstract

Physical and psychological impairment resulting from traumatic injuries is often significant and affects employment and functional independence. Extremity trauma has been shown to negatively affect long-term self-reported physical function, the ability to work, and participation in recreational activities and contributes to increased rates of anxiety and/or depression. High pain levels early in the recovery process and psychosocial factors play a prominent role in recovery after traumatic lower extremity injury. Cognitive-behavioral therapy pain programs have been shown to mitigate these effects. However, patient access issues related to financial and transportation constraints and the competing demands of treatment focused on the physical sequelae of traumatic injury limit patient participation in this treatment modality. This article describes a telephone-delivered cognitive-behavioral-based physical therapy (CBPT-Trauma) program and design of a multicenter trial to determine its effectiveness after lower extremity trauma. Three hundred twenty-five patients from 7 Level 1 trauma centers were randomized to CBPT-Trauma or an education program after hospital discharge. The primary hypothesis is that compared with patients who receive an education program, patients who receive the CBPT-Trauma program will have improved physical function, pain, and physical and mental health at 12 months after hospital discharge.

Postoperative Negative Pain Thoughts and Their Correlation With Patient-Reported Outcomes After Arthroscopic Rotator Cuff Repair: An Observational Cohort Study

“…2,6,8 Using techniques such as CBT and mindfulness practices, patients can engage in cognitive reframing to reduce pain, and these techniques can be used postoperatively to improve patients’ thought patterns. 1,7 To identify patients in the preoperative setting who may benefit from tools such as CBT before surgery, we aimed to measure the relationship between preoperative NPTQ-SF scores and postoperative outcomes. The results of our study suggest that the NPTQ-SF cannot be used to predict postoperative outcomes associated with negative cognitive bias regarding pain in patients undergoing RCR.…”

Cognitive-Behavioral-Based Physical Therapy for Improving Recovery After a Traumatic Lower-Extremity Injury

“…Statistical analyses of the primary and secondary outcomes at 6 and 12 months after hospital discharge followed the intention-to-treat paradigm 30 . The primary outcome of physical function was measured using the PROMIS PF at 6 and 12 months.…”

“…T his study was a multicenter, randomized controlled trial whose design, including the intervention, has previously been described in detail 30 . From 6 Level-I trauma centers, 325 participants with a traumatic lower-extremity injury were recruited and were randomized to either the CBPT program or a control group with a standardized education program.…”

“…The key elements of both CBPT and education control programs have been previously described 30 . Two licensed physical therapists with >10 years of experience treating patients with musculoskeletal pain delivered the programs remotely by telephone to all patients in the treatment group.…”

Musculoskeletal Pain Management and Patient Mental Health and Well-being

“…This randomized controlled trial will compare outcomes (physical function, pain, and physical and mental health) among patients who receive the CBPT-Trauma Program to patients offered educational resources. 36 Furthermore, cognitive behavioral interventions are crucial to breaking the cycle between pain catastrophizing and kinesiophobia, which can lead to poor physical recovery and poor mental health. 37…”