Physiotherapy informed by Acceptance and Commitment Therapy for chronic low back pain: A mixed‐methods treatment fidelity evaluation

Abstract

Objectives. A randomized controlled trial of a new type of Physiotherapy informed by Acceptance and Commitment Therapy (PACT), found that it improved functioning in people with chronic low back pain compared to usual physiotherapy care. Fidelity evaluation is necessary to understand trial processes and outcomes. This study evaluated PACT treatment fidelity including delivery, receipt, and enactment. Design.A mixed-methods study nested within a randomized controlled trial was conducted.Methods. A total of 72 (20% of total) PACT treatment audio files were independently assessed by two raters, according to a novel framework developed to measure PACT treatment content adherence, therapeutic alliance, ACT competence, and treatment enactment. Interview transcripts from 19 trial participants randomized to PACT were analysed thematically for evidence of treatment receipt and enactment.Results. PACT physiotherapists delivered treatment as intended with high content adherence and satisfactory therapeutic alliance, but ACT competence was low. Qualitative findings indicated participant receipt of 11/17 and enactment of 3/17 components; 89% (n = 17) and 47% (n = 9) of participants reported treatment receipt and enactment of at least one component, respectively.Conclusions. This mixed-methods study of PACT treatment demonstrated high fidelity reflecting treatment content delivery and receipt, and therapeutic alliance. There was some evidence of treatment enactment in participants with chronic low back pain.

The GLA:D BACK self‐management adherence and competence checklist (SMAC Checklist)—Development, content validity and feasibility

“…To identify the challenges that clinicians face, there is a need for practice‐based investigations of the delivery of complex interventions. Clinicians managing musculoskeletal pain conditions have often been trained from a biomedical understanding and find it challenging to deliver psychologically informed care including the use of self‐management supportive communication (Cowell et al, 2018, 2021; Denneny et al, 2020; Galea Holmes et al, 2022; Pincus et al, 2013; Richmond et al, 2018; Synnott et al, 2015). Despite this, or perhaps because of this, our focus group with clinicians revealed a pull for quality development of treatment delivery and no reluctance towards being observed.…”

“…They are operationalized in a comprehensive BCT taxonomy (Michie et al, 2015) that has shown useful for decomposing interventions into active elements and for evaluating treatment fidelity in clinical trials (Beck et al, 2016;Keogh, Matthews, & Hurley, 2018;Tate et al, 2016;Toomey et al, 2020). Furthermore, clinicians' communication can be evaluated by assessing components of specific communication techniques/styles (Galea Holmes et al, 2022;Murray et al, 2015Murray et al, , 2018.…”

“…Treatment delivery may be simple to define with pharmacological treatments because the content is well‐described and easy to define. It is more challenging with complex behaviour change interventions consisting of multiple components where intended delivery may not be straightforward to define (Galea Holmes et al, 2022; Ginsburg et al, 2021; Hodder et al, 2016; Mansell et al, 2016; Walton et al, 2017). Still, it is possible to evaluate such interventions through the assessment of behaviour change techniques (BCT) and communication styles used in patient–clinician interactions.…”

Acceptance and Commitment Therapy is feasible for people with acquired brain injury: A process evaluation of the BrainACT treatment

“…2,10,11 However, it is higher compared to a study investigating Acceptance and Commitment Therapy for cancer survivors (70%), 12 but lower than a study examining this therapy for people with chronic lower back pain (80%). 13 The somewhat low compliance rate is likely due to the fact that therapists thought that the content of the sessions was often too much and therefore they did not cover all the elements. This was especially the case concerning interventions delivered through video-conferencing.…”

Digital Therapeutics (DTx) Expand Multimodal Treatment Options for Chronic Low Back Pain: The Nexus of Precision Medicine, Patient Education, and Public Health

“…To address both the complexity of etiology and the diversity of risk factors for CLBP, the multimodal approach offers apparent advantages over monotherapies. Combining physical and psychological therapies for CLBP offer additional benefits; for example, PT and CBT or ACT can further improve pain relief and disability as compared to PT alone [90][91][92]. A multidisciplinary 8-week restoration program for CLBP patients was created by combining physical and psychological interventions (functional strength, calisthenics, aerobics, stretching, education, socioeconomic counseling, and CBT) [93].…”