Optimizing management of low back pain through the pain and disability drivers management model: A feasibility trial

Abstract

Introduction Self-reported levels of disability in individuals with low back pain (LBP) have not improved in the last decade. A broader perspective and a more comprehensive management framework may improve disability outcomes. We recently developed and validated the Low Back Pain and Disability Drivers Management (PDDM) model, which aims to identify the domains driving pain and disability to guide clinical decisions. The objectives of this study were to determine the applicability of the PDDM model to a LBP population and the feasibility of conducting a pragmatic trial, as well as to explore clinicians’ perceived acceptability of the PDDM model’s use in clinical settings. Methods This study was an one-arm prospective feasibility trial. Participants included physiotherapists working with a population suffering from LBP and their patients aged 18 years or older presenting with a primary complaint of LBP that sought a new referral and deemed fit for rehabilitation from private and public clinical settings. Clinicians participated in a one-day workshop on the integration of the PDDM model into their clinical practice, and were asked to report various LBP-related outcomes via self-reported questionnaires (i.e., impact of pain on physical function, nervous system dysfunctions, cognitive-emotional factors, work disabilities) at baseline and at six-week follow-up. Physiotherapists’ acceptability of the use of the PDDM model and appreciation of the training were assessed via semi-structured phone interviews. Analyses focused on a description of the model’s applicability to a LBP population, feasibility outcomes and acceptability measures. Results Applicablity of the PDDM model was confirmed since it successfully established the profile of patients according to the elements of each categories, and each of the 5 domains of the model was represented among the study sample. Trial was deemed feasible contingent upon few modifications as our predefined success criteria for the feasibility outcomes were met but feasibility issues pertaining to data collection were highlighted. Twenty-four (24) clinicians and 61 patients were recruited within the study’s timeframe. Patient’s attrition rate (29%) and clinicians’ compliance to the study protocol were adequate. Clinicians’ perceived acceptability of the use of the model in clinical settings and their appreciation of the training and online resources were both positive. Recommendations to improve the model’s integration in clinical practice, content of the workshop and feasibility of data collection methods were identified for future studies. A positive effect for all patients’ reported outcome measures were also observed. All outcome measures except for the PainDetect questionnaire showed a statistically significant reduction post-intervention (p<0.05). Conclusion These findings provide preliminary evidence of the potential of the PDDM model to optimize LBP management as well as conducting a future larger-scale pragmatic trial to determine its effectiveness. Trial registration Clinicaltrial.gov: NCT03949179.

Development and content validity of a rating scale for the pain and disability drivers management model

“…The development of the PDDM rating scale opens the door to the proposals of recommended interventions, based on the patient’s profile. These treatment proposals are one of the needs highlighted by participants in our feasibility trial [ 9 ]. Establishing a profile could also help clinicians modify the patient’s biomedical beliefs and expectations [ 25 – 28 ].…”

“…The PDDM model, described in detail elsewhere [ 6 ], served as the theoretical framework upon which the tool was constructed. The feasibility trial provided evidence for the relevance of establishing the patient’s profile according to the presence or absence of the categories within each domain [ 9 ]. Thus, we developed a 5-item rating scale (1 item for each domain) to detect the presence or absence of these categories.…”

“…More recently, we determined the applicability of the PDDM model and explored clinicians’ perceived acceptability of its use in clinical settings, where 24 clinicians were trained to apply the PDDM model to guide their management of 61 patients [ 9 ]. The model contributed positively to the biopsychosocial assessment and better understanding of the psychosocial factors [ 9 ], which facilitated the development of a personalized management plan, including a referral process to another professional when deemed necessary [ 9 ].…”

“…As the PDDM model showed, it can be utilized to overcome certain barriers associated with the integration of a biopsychosocial perspective in clinical practice [ 10 – 13 ] and induced positive changes on various clinical outcomes [ 9 ].…”

Back pain treatment: a new perspective

“… 53 In addition there are data from a feasibility study that shows preliminary evidence that this model might have potential to improve NSLBP management, although the application was carried out by physiotherapists alone rather than an interdisciplinary team. 54 …”