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J Pain. 2019 Jun 4. pii: S1526-5900(19)30065-3. doi: 10.1016/j.jpain.2019.05.012. [Epub ahead of print]

Physical therapy informed by Acceptance and Commitment Therapy (PACT) versus usual care physical therapy for adults with chronic low back pain: a randomised controlled trial.

Author information

1
Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 5th Floor Bermondsey, Guy's Campus, London SE1 9RT, UK. Electronic address: emma.l.godfrey@kcl.ac.uk.
2
Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 5th Floor Bermondsey Wing, Guy's Campus, London SE1 9RT, UK.
3
Guy's and St Thomas' Hospital NHS FT F01 Block B, South Wing, St Thomas' Hospital, London SE1 7EH, UK.
4
King's College Hospital NHS Foundation Trust, 4th Floor Hambledon Wing, Denmark Hill, London SE5 9RS, UK.
5
Department of Physiotherapy, School of Population Health & Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, 3rd Floor, Shepherds House, Guy's Campus, London SE1 1UL, UK.

Abstract

Chronic low back pain (CLBP) is a major cause of global disability and improving management is essential. Acceptance and Commitment Therapy (ACT) is a promising treatment for chronic pain but has not been modified for physical therapy. This randomized controlled trial (RCT) compared physical therapy informed by Acceptance and Commitment Therapy (PACT) against standard care physical therapy for patients with CLBP. Patients with CLBP (duration ≥12 weeks, mean 3 years) were recruited from physical therapy clinics in four UK public hospitals. The Roland-Morris Disability Questionnaire (RMDQ) at 3 months' post randomization was the primary outcome. 248 participants (59% female, mean age=48) were recruited and 219 (88•3%) completed measures at 3 and/or 12 months' follow-up. At 3 months, PACT participants reported better outcomes for disability (RMDQ mean difference =1•07, p=0•037, 95%CI -2•08 to -0•07, d=0•2), Patient Specific Functioning (p=0.008), SF12 physical health (p=0.032), and treatment credibility (p<0.001). At 12 months' follow-up there were no significant differences between groups. PACT was acceptable to patients and clinicians and feasible to deliver. Physical therapists incorporated psychological principles successfully and treatment was delivered with high (≥80%) fidelity. Our results may inform the management of CLBP, with potential benefits for patients, health care providers and society. PERSPECTIVE: Psychologically informed physical therapy has great potential but there are challenges in implementation. The training and support included in the PACT trial enabled the intervention to be delivered as planned. This successfully reduced disability in the short but not long term. Findings could inform physical therapists' treatment of CLBP.

KEYWORDS:

Acceptance and Commitment Therapy; Chronic low back pain; Physical Therapy; Randomized Controlled Trial

PMID:
31173921
DOI:
10.1016/j.jpain.2019.05.012
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