Identifying psychosocial characteristics that predict outcome to the UPLIFT programme for people with persistent back pain: protocol for a prospective cohort study

Abstract

IntroductionPrognostic screening of people with low back pain (LBP) improves utilisation of primary healthcare resources. Whether this also applies to secondary healthcare remains unclear. Therefore, this study aims to develop prognostic models to determine at baseline which patients with persistent LBP are likely to have a good and poor outcome to a 5-week programme of combined education and exercise (‘UPLIFT’) delivered in a secondary healthcare setting.Methods and analysisA prospective cohort study of 246 people with persistent LBP will be conducted in a secondary healthcare outpatient setting. Patients will be recruited from a physiotherapy-led neurosurgical screening clinic. Demographic data, medical history and psychosocial characteristics will be recorded at baseline. Fear avoidance beliefs, pain self-efficacy, LBP treatment beliefs, pain catastrophising, perceived injustice, depression, anxiety and stress, disability level, pain intensity and interference, health status and social connectedness will be considered as potential prognostic variables, which will be assessed using self-reported questionnaires. Participants will attend the UPLIFT programme, consisting of weekly 90 min group sessions that combine interactive education sessions and a graded exercise programme. The outcome measure to identify good and poor outcome is the Global Rating of Change scale, assessed at completion of the UPLIFT programme and at 6 months follow-up. Multiple imputation analyses will be performed for missing values. Prognostic models will be developed using multivariable logistic regression analyses, with bootstrapping techniques for internal validation. We will calculate the explained variance of the models and the area under the receiver operating characteristic curve. Furthermore, we will determine whether participation in the UPLIFT programme is associated with changes in psychosocial characteristics.Ethics and disseminationGold Coast Health Service Human Research Ethics Committee (HREC/18/QGC/41) and the Griffith University Human Research Ethics Committee (GU Ref No: 2018/408) approved the study. Dissemination of findings will occur via peer-reviewed publications and conference presentations.Trial registration numberACTRN12618001525279.

Biopsychosocial rehabilitation in the working population with chronic low back pain: a concept analysis

“…Pain education ( 23 , 25 , 37 , 40 , 50 , 57 , 61 – 63 , 67 , 72 , 73 ), psycho-/CBT education ( 23 , 24 , 40 , 45 , 48 , 51 , 66 , 67 ), back ergonomics ( 36 , 37 , 42 , 45 ), anatomy and physiology ( 24 , 37 , 50 , 54 ), and education on the BPS model ( 38 , 49 , 50 , 65 ) were taught the most. Other prevalent education topics included education on body awareness ( 24 , 54 ); re-educating the body-self neuro-matrix ( 40 ); giving a booklet ( 45 , 55 ); lessons on fear avoidance and beliefs ( 40 , 53 , 61 ); risk factors ( 50 , 56 , 66 , 73 ); symptom maintenance ( 56 ); expectations ( 64 ); prevalence and course of disease ( 65 , 73 ); and activity pacing, management of flare-ups and load-capacity balance ( 50 , 67 ). Eight references did not report in-depth information on the educational approach ( 35 , 43 , 47 , 58 , 60 , 68 , 69 , 71 ).…”

“…The first and second sub-attributes: individualization/tailoring ( 23 – 25 , 36 – 41 , 44 – 46 , 48 – 55 , 57 , 58 , 60 – 62 , 64 , 66 – 69 , 71 , 72 ) and guidance ( 23 – 25 , 38 – 41 , 46 , 48 , 51 , 57 , 58 , 63 , 64 , 71 ), appear the most, in 32 and 15 references, respectively. The other 7 sub-attributes are less prevalent: interdisciplinary communication ( 23 – 25 , 38 , 60 , 65 , 66 , 69 , 72 ), patient-centeredness ( 24 , 25 , 57 , 64 , 65 , 72 ), therapist consistency ( 24 , 48 , 55 , 65 ), graded activity ( 23 , 62 , 66 , 67 ), biofeedback ( 23 , 54 ), protocol induced ( 44 , 45 ), and shared decision-making ( 50 , 61 ).…”

“…The sub-attribute protocol induced implies that the patient exclusively participates in the intervention and ceases all other therapies. An overarching personalized exercise is described as graded activity ( 23 , 62 , 66 , 67 ). This specific type of exercise has overarching modalities, such as endurance and strength.…”

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

“…[7][8][9] Although complex, multidisciplinary interventions, including both exercise interventions and cognitive behavioural interventions, have in general shown positive effects in the treatment in low back pain populations, [10][11][12] the management of patients referred to the secondary care setting often propose a particularly challenging task for healthcare professionals. 3,13 This group of patients often present with high pain levels, reduced functional ability, poor pain coping strategies (e.g. fear of pain and movement, catastrophic thoughts about pain, anxiety and bodily distress), and a history of failed treatment attempts.…”

“…fear of pain and movement, catastrophic thoughts about pain, anxiety and bodily distress), and a history of failed treatment attempts. 13 The evidence in support of complex interventions targeting this more vulnerable group of patients is weak and limited.…”