Description of content, structure and theoretical model of a group-based pain management programme in the treatment of patients with persistent non-specific low back pain and psychological risk factors in a secondary sector setting

Abstract

Objective: To present the theoretical foundation and methodological considerations for a group-based pain management programme for patients with persistent non-specific low back pain and psychosocial risk factors. Method: The Template for Intervention Description and Replication (TIDieR) checklist was used as a framework for describing the content, structure and context of the program. The theoretical rationale underlying the pain management programme was described using the first three steps of the Intervention Mapping framework. The Fear-avoidance model and the Self-efficacy Theory were identified as the two main theories. These were used to establish specific factors addressed by the pain management programme as well as expected outcomes. Intervention description: A multidisciplinary, group-based programme using a cognitive-behavioural approach was developed. The programme consisting of six sessions of two hours duration, took place at a spine clinic at a regional hospital in Denmark. Psychoeducation and cognitive restructuring were specific strategies hypothesised to induce changes in outcome measures. The outcomes expected to change as a result of the intervention were disability, quality of life, sick leave and physical activity. A pilot study was performed, subsequent adjustments made and the final content and educational materials completed by January 2017. Conclusion: The theoretical foundation and underlying evidence for the hypothesised change mechanisms in the use of a cognitive-behavioural approach was presented. A theoretically sound and practically feasible intervention has been developed and its effectiveness is being determined in a randomised controlled trial, including 130 low back pain patients, which is currently underway.

Does group-based cognitive therapy improve functional ability, pain, catastrophic thoughts and quality of life in patients with persistent low back pain and psychological risk factors? A randomised controlled trial in a secondary care setting

“…A detailed description of the intervention design and rationale has been published elsewhere, to enable replication of the study and to facilitate comparison across studies. 18 Although previous studies have shown that non-psychologists can indeed deliver psychological interventions to manage low back pain effectively, 40 we chose to let a psychologist supervise the physiotherapists and nurses delivering the intervention to ensure the therapeutic quality. This approach is in line with the recommendations put forward in a systematic review by Hall et al stating that cognitive behavioural therapy providers should undergo training in order to secure a high level of treatment fidelity, and therefore, healthcare professionals are recommended to engage in initial training or supervision by experienced psychologists.…”

“…The details and theoretical foundation for the intervention has been published elsewhere. 18 In brief, the programme consisted of six group-based sessions each lasting two hours, spanning a time-frame of three months in total. All sessions were delivered face-to-face at the Spine Center.…”

“…The content of the homework assignments is available in the publication describing the intervention. 18…”

“…17 An in-depth description of the literature on the effects of cognitive behavioural techniques in low back pain management in general, and in relation to the rationale for the intervention provided in this study specifically, has been published elsewhere. 18…”

The behaviours identified and the behaviour change techniques planned in health partnerships for antimicrobial stewardship

“…The TIDieR framework can be used to describe the main features of an intervention, which is key to understanding and supporting implementation (Hoffmann et al, 2014). The TIDieR framework has been applied to describe the content and contexts of interventions from group‐based pain management interventions (Skovbo et al, 2021), to population health and policy interventions (Campbell et al, 2018). The AACTT framework specifies behaviours by Actor, Action, Context, Target and Time and supports research and intervention development by identifying who needs to do what differently by specifying behaviours (Presseau et al, 2019).…”