Journal Article

Targeted interventions to prevent transitioning from acute to 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

George, Steven Z., Greco, Carol M., Saper, Robert B., Beneciuk, Jason M., Delitto, Anthony, Schneider, Michael J., Wegener, Stephen T.

2019

Overview

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-h 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, NCT02647658 . Registered on 6 January 2016.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Acute Pain - diagnosis / Acute Pain - physiopathology / Acute Pain - psychology / Acute Pain - therapy / Adult / Analysis / Attitude of Health Personnel / Back pain / Behavior modification / Biomedicine / Chronic pain / Chronic Pain - diagnosis / Chronic Pain - physiopathology / Chronic Pain - psychology / Chronic Pain - therapy / Clinical medicine / Clinical psychology / Clinical trials / Complications and side effects / Continuing education / Cost control / Curriculum / Disabilities / Disease Progression / Education / Education, Professional / Experiential learning / Feasibility studies / Feedback / Health Knowledge, Attitudes, Practice / Health Sciences / Humans / Low back pain / Low Back Pain - diagnosis / Low Back Pain - physiopathology / Low Back Pain - psychology / Low Back Pain - therapy / Medicine / Medicine & Public Health / Methodology / Middle Aged / Patient-Centered Care / Patients / Physical therapists / Physical Therapists - education / Physical Therapists - psychology / Physical therapy / Physical Therapy Modalities - education / Post-professional education / Prevention / Primary care / Psychologically informed physical therapy / Public health / Quality improvement / Risk Assessment / Risk Factors / Secondary Prevention - education / Stakeholders / Statistics for Life Sciences / Task forces / Training / United States / Workshops (Educational programs)