Pragmatic Implementation of a Stratified Primary Care Model for Low Back Pain Management in Outpatient Physical Therapy Settings: Two-Phase, Sequential Preliminary Study

Beneciuk, Jason M.; George, Steven Z.

doi:10.2522/ptj.20140418

Cited by 64 publications

(83 citation statements)

References 54 publications

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“…For example, a targeted psychologically informed management approach using the Keele STarT Back Screening Tool as a stratification measure for acute low back pain has been developed and shown to be more effective than non‐stratified primary care in the United Kingdom (Hill et al, ). Several follow‐up investigations have attempted to adapt and implement a similar approach in U.S. primary care settings (Cherkin et al, ) and outpatient physical therapy (Beneciuk & George, ). The Keele STarT Back Screening Tool is a short (nine items) and easy to administer questionnaire that is clinically feasible for determining psychosocial risk in patients with low back pain.…”

Section: Discussionmentioning

confidence: 99%

Preoperative and postoperative psychologically informed physical therapy: A systematic review of randomized trials among patients with degenerative spine, hip, and knee conditions

Coronado

Patel

McKernan

et al. 2019

J Appl Biobehavioral Res

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Purpose: To summarize evidence on preoperative and postoperative psychologically informed physical therapy (PIPT) for improving outcomes after degenerative spine, hip, or knee surgery. Methods: Four electronic databases were searched.Randomized trials were included if they examined the efficacy of a preoperative or postoperative intervention involving the delivery of psychologically based strategies by a physical therapist for improving function/disability, pain, quality of life, or psychological factors. Outcomes at 12 months or longer were considered long-term.Results: Twelve articles representing 10 unique studies (total N = 1,127 patients, 636 (56.4%) females) in lumbar (n = 7) or cervical spine surgery (n = 1), total knee arthroplasty (n = 1), and total knee/hip arthroplasty (n = 1) were included. The most common PIPT components were coping skills training, psychoeducation, and positive reinforcement. Greater improvements following PIPT were reported in 5 (56%) studies for function/disability, 6 (60%) for pain, 5 (71%) for quality of life, and 7 (70%) for psychological factors. Of these, greater long-term benefit was reported

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Section: Discussionmentioning

confidence: 99%

Preoperative and postoperative psychologically informed physical therapy: A systematic review of randomized trials among patients with degenerative spine, hip, and knee conditions

Coronado

Patel

McKernan

et al. 2019

J Appl Biobehavioral Res

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“…In contrast, minimal changes were observed for clinicians that did not participate in the stratified care and PIPT training module. Furthermore, therapists who received PIPT training had better 4-week patient clinical outcomes for pain intensity and self-reported disability compared to therapists who were not trained (26). There is a timely opportunity for striking a balance between lengthy comprehensive training programs and pragmatic single day courses.…”

Section: Trial Registrationmentioning

confidence: 99%

“…(Figure 1) Training Background Development of the PIPT training program was guided by previous protocols that have tested risk stratification approaches for LBP using the STarT Back Tool (21,24). In addition, members of the TARGET intervention team (JMB and SZG) provided PIPT training for a small scale feasibility study, training providers within a single healthcare system (26). Key developers of the TARGET Trial PIPT training program consisted of physical therapy, clinical psychology and chiropractic providers.…”

Section: Pipt Training Programmentioning

confidence: 99%

Targeted Interventions to Prevent Chronic Low Back Pain in High Risk Patients: Development and Delivery of a Pragmatic Training Course of Psychologically Informed Physical Therapy for the TARGET Trial

Beneciuk

George

Greco

et al. 2019

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Background Low back pain (LBP) is a public health concern because it is highly prevalent and the leading cause of disability worldwide. Psychologically Informed Physical Therapy (PIPT) is secondary prevention approach that first aims to identify individuals at high risk for transitioning to chronicity and then provides tailored treatment to reduce that risk. Training models that are feasible to implement with acceptable training quality are needed to improve scalability for widespread implementation of PIPT. This manuscript describes the PIPT training program that was developed for training physical therapists providing PIPT in the TARGET Trial. Methods The PIPT training program was developed, tested, and modified using an iterative process. Content development consisted of stakeholder engagement, beta testing, modification of training and confirmation of final course objectives. Methods of delivery consisted of a website that included brief educational modules followed by a live 8 hour workshop that included video based mock case scenarios and case-based role playing. Attitudes, beliefs and confidence in implementing PIPT principles were assessed before and immediately after training to measure training quality and impact. Results Early stakeholder engagement and beta testing indicated the need for increased emphasis on experiential learning opportunities and patient-centered communication training. Booster training varied extensively across TARGET sites with involvement of ‘clinician champions’ brief follow-up sessions identified as best practice. Favorable post training changes in physical therapist attitudes and beliefs toward biopsychosocial treatment orientation and increased confidence in implementing PIPT principles were observed. Conclusions PIPT training for provider participation in the TARGET Trial was feasible to deliver. Course content was acceptable to physical therapists and resulted in improved beliefs and confidence in applying PIPT skills during clinical practice. Ongoing consultation and site-based continuing education were methods by which specific TARGET sites maintained or augmented PIPT skill training, however implementing ongoing training was challenging in general. Consistent with a pragmatic trial whether this training directly impacted treatment fidelity was not measured, which was a limitation to our training approach. Trial registration ClinicalTrials.gov Identifier: NCT02647658

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“…Identification of multiple prognostic indicators may be improved by utilizing validated screening and psychosocial assessment tools. These tools can help identify patients at‐risk for poor outcomes, patient subgroups in need of targeted psychosocial interventions, and patients that need an appropriate referral (Beneciuk & George, ; Hill et al, ).…”

Section: Introductionmentioning

confidence: 99%

Assessing psychosocial profile in the physical therapy setting

Wyngaarden

Noehren

Archer

2019

J Appl Biobehavioral Res

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Purpose Physical therapists play a crucial role in managing persistent pain and disability. Since psychosocial factors are important predictors of poor patient outcomes, it is essential that clinicians understand how to utilize validated instruments to assess psychosocial profile in the clinical setting. The following article reviews the psychometric properties and clinical application of the Keele Subgroups for Targeted Treatment Back Screening Tool (SBT), Optimal Screening for Prediction of Referral and Outcome Yellow Flag (OSPRO‐YF), Pain Catastrophizing Scale (PCS), Tampa Scale of Kinesiophobia (TSK), Pain Self‐Efficacy Questionnaire (PSEQ), and Patient Health Questionnaire (PHQ). Results Multidimensional screening tools, such as the SBT and OSPRO‐YF, are useful prognostic indicators of long‐term disability and the presence of yellow flags that may be contributing to patient presentation, respectively. This can guide both the treatment and administration of specific, unidimensional psychosocial assessment tools. The following cutoffs are identified as moderate elevation of psychosocial profile which can be used to inform clinical practice: PCS ≥20, TSK >37, PSEQ ≥40, and PHQ‐9 ≥10. Conclusion Valid and reliable unidimensional and multidimensional psychosocial assessment tools provide important prognostic information to inform a patient's psychosocial profile and subsequently improve clinical efficiency and patient outcomes.

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Pragmatic Implementation of a Stratified Primary Care Model for Low Back Pain Management in Outpatient Physical Therapy Settings: Two-Phase, Sequential Preliminary Study

Abstract: In physical therapy settings, biomedical orientation can be modified, and risk-stratified care for LBP can be effectively implemented. Findings from this study can be used for planning of larger studies.

Cited by 64 publications

References 54 publications

Preoperative and postoperative psychologically informed physical therapy: A systematic review of randomized trials among patients with degenerative spine, hip, and knee conditions

Preoperative and postoperative psychologically informed physical therapy: A systematic review of randomized trials among patients with degenerative spine, hip, and knee conditions

Targeted Interventions to Prevent Chronic Low Back Pain in High Risk Patients: Development and Delivery of a Pragmatic Training Course of Psychologically Informed Physical Therapy for the TARGET Trial

Assessing psychosocial profile in the physical therapy setting

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