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

Abstract

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 a 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 online 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’ providing 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. Due to the pragmatic nature of the TARGET trial, it was not possible to directly measure the effect of PIPT training on treatment fidelity which was a limitation of our approach. Trial registration: ClinicalTrials.gov Identifier: NCT02647658