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Objective Disparities exist in health care access, diagnosis, and treatment of chronic pain in Latino populations and other minority populations. Cognitive behavioral–based physical therapy (CBPT) interventions have been shown to be effective in predominantly non-Hispanic white populations with chronic spine pain. However, there is a need for culturally adapted CBPT interventions that focus on the conservative management of chronic spine pain. The primary purpose of the study described in this protocol is to test the efficacy of an adapted cognitive behavioral–based hybrid telerehabilitation intervention for Latino patients with chronic spine pain. Methods A single-blind, 2-arm parallel group, superiority randomized clinical trial is planned to compare an adapted CBPT intervention to Usual Care physical therapy. Goal Oriented Activity for Latinos with chronic Spine pain (GOALS/Metas) is an 8-week hybrid telerehabilitation intervention that integrates guideline-based physical therapy and pain management interventions using cognitive behavioral approaches and has been adapted for Latino patients with chronic spine pain. Usual Care physical therapy will be administered based on institutional standards at the referring health center. Outcome measures will be evaluated preintervention and at 1-week, 3-months, and 6-months postintervention. The primary outcome is pain-related disability 1-week postintervention using the Brief Pain Inventory Pain Interference subscale. Secondary outcome measures include behavioral measures of functional activity, social participation, physical activity, and sleep. Determinants of treatment effect, including pain-related psychological measures, posture and movement, self-efficacy, treatment expectancy, and therapeutic alliance, will be included in the secondary moderation and mediation analyses. Impact This clinical trial will provide information on the extent to which an adapted CBPT hybrid telerehabilitation intervention is effective in reducing pain-related disability for Latino patients with chronic spine pain. This information will be useful for clinicians to integrate in their practice, given the growing population of Latino patients who experience disparities in health care management of chronic pain. [ABSTRACT FROM AUTHOR]

Objective The purpose of this study was to examine the association between goal attainment and patient-reported outcomes in patients who engaged in a 6-session, telephone-based, cognitive-behavioral–based physical therapy (CBPT) intervention after spine surgery. Methods In this secondary analysis of a randomized trial, data from 112 participants (mean age = 63.3 [SD = 11.2] years; 57 [51%] women) who attended at least 2 CBPT sessions (median = 6 [range = 2–6]) were examined. At each session, participants set weekly goals and used goal attainment scaling (GAS) to report goal attainment from the previous session. The number and type of goals and percentage of goals met were tracked. An individual GAS t score was computed across sessions. Participants were categorized based on goals met as expected (GAS t score ≥ 50) or goals not met as expected (GAS t score < 50). Six- and 12-month outcomes included disability (Oswestry Disability Index), physical and mental health (12-Item Short-Form Health Survey), physical function (Patient-Reported Outcomes Measurement Information System), pain interference (Patient-Reported Outcomes Measurement Information System), and back and leg pain intensity (numeric rating scale). Outcome differences over time between groups were examined with mixed-effects regression. Results Participants set a median of 3 goals (range = 1–6) at each session. The most common goal categories were recreational/physical activity (36%), adopting a CBPT strategy (28%), exercising (11%), and performing activities of daily living (11%). Forty-eight participants (43%) met their goals as expected. Participants who met their goals as expected had greater physical function improvement at 6 months (estimate = 3.7; 95% CI = 1.0 to 6.5) and 12 months (estimate = 2.8; 95% CI = 0.04 to 5.6). No other outcome differences were noted. Conclusions Goal attainment within a CBPT program was associated with 6- and 12-month improvements in postoperative physical functioning. Impact This study highlights goal attainment as an important rehabilitation component related to physical function recovery after spine surgery. [ABSTRACT FROM AUTHOR]

Objective Changing Behavior through Physical Therapy (CBPT), a cognitive-behavioral–based program, has been shown to improve outcomes after lumbar spine surgery in patients with a high psychosocial risk profile; however, little is known about potential mechanisms associated with CBPT treatment effects. The purpose of this study was to explore potential mediators underlying CBPT efficacy after spine surgery. Methods In this secondary analysis, 86 participants were enrolled in a randomized trial comparing a postoperative CBPT (n = 43) and education program (n = 43). Participants completed validated questionnaires at 6 weeks (baseline) and 3 and 6 months following surgery for back pain (Brief Pain Inventory), disability (Oswestry Disability Index), physical health (12-Item Short-Form Health Survey), fear of movement (Tampa Scale for Kinesiophobia), pain catastrophizing (Pain Catastrophizing Scale), and pain self-efficacy (Pain Self-Efficacy Questionnaire). Parallel multiple mediation analyses using Statistical Package for the Social Sciences (SPSS) were conducted to examine whether 3- and 6-month changes in fear of movement, pain catastrophizing, and pain self-efficacy mediate treatment outcome effects at 6 months. Results Six-month changes, but not 3-month changes, in fear of movement and pain self-efficacy mediated postoperative outcomes at 6 months. Specifically, changes in fear of movement mediated the effects of CBPT treatment on disability (indirect effect = −2.0 [95% CI = −4.3 to 0.3]), whereas changes in pain self-efficacy mediated the effects of CBPT treatment on physical health (indirect effect = 3.5 [95% CI = 1.2 to 6.1]). Conclusions This study advances evidence on potential mechanisms underlying cognitive-behavioral strategies. Future work with larger samples is needed to establish whether these factors are a definitive causal mechanism. Impact Fear of movement and pain self-efficacy may be important mechanisms to consider when developing and testing psychologically informed physical therapy programs. [ABSTRACT FROM AUTHOR]

Background: Low back pain is a prevalent condition that causes a substantial health burden. Despite intensive and expensive clinical efforts, its prevalence is growing. Nonpharmacologic treatments are effective at improving pain-related outcomes; however, treatment effect sizes are often modest. Physical therapy (PT) and cognitive behavioral therapy (CBT) have the most consistent evidence of effectiveness. Growing evidence also supports mindfulness-based approaches. Discussions with providers and patients highlight the importance of discussing and trying options to find the treatment that works for them and determining what to do when initial treatment is not successful. Herein, we present the protocol for a study that will evaluate evidence-based, protocol-driven treatments using PT, CBT, or mindfulness to examine comparative effectiveness and optimal sequencing for patients with chronic low back pain.Methods: The Optimized Multidisciplinary Treatment Programs for Nonspecific Chronic Low Back Pain (OPTIMIZE) Study will be a multisite, comparative effectiveness trial using a sequential multiple assessment randomized trial design enrolling 945 individuals with chronic low back pain. The co-primary outcomes will be disability (measured using the Oswestry Disability Index) and pain intensity (measured using the Numerical Pain Rating Scale). After baseline assessment, participants will be randomly assigned to PT or CBT. At week 10, participants who have not experienced at least 50% improvement in disability will be randomized to cross-over phase-1 treatments (e.g., PT to CBT) or to Mindfulness-Oriented Recovery Enhancement (MORE). Treatment will consist of 8 weekly sessions. Long-term outcome assessments will be performed at weeks 26 and 52.Discussion: Results of this study may inform referring providers and patients about the most effective nonoperative treatment and/or sequence of nonoperative treatments to treat chronic low back pain.Trial Registration: This study was prospectively registered on March 1, 2019, with Clinicaltrials.gov under the registration number NCT03859713 (https://clinicaltrials.gov/ct2/show/NCT03859713). [ABSTRACT FROM AUTHOR]

Musculoskeletal injury is a leading cause of pain and disability worldwide; 35% to 75% of people experience persistent pain for months and years after injury. Psychological treatments can reduce pain, functional impairment, and psychological distress but are not widely used after injury. This systematic review and meta-analysis (PROSPERO ID: CRD42021236807) aimed to synthesize the literature testing psychological treatments for pain after musculoskeletal injury. We searched EMBASE, MEDLINE, PubMed, PsycINFO, and CENTRAL from inception to May 2022. We extracted participant, treatment, and injury characteristics and primary (eg, pain intensity, functional impairment, depression, anxiety, and PTSD symptoms) and secondary (treatment feasibility and acceptability) outcomes. Twenty-four randomized controlled trials (N = 1966) were included. Immediately posttreatment, people who received psychological treatments (versus any control) reported lower pain intensity (standardized mean differences [SMD] = −0.25, 95% confidence interval [−0.49, −0.02]), functional impairment (SMD = −0.32 [−0.55, −0.09]), and symptoms of depression (SMD = −0.46 [−0.64, −0.29]), anxiety (SMD = −0.34 [−0.65, −0.04]), and PTSD (SMD = −0.43 [−0.70, −0.15]); at 6-month follow-up, only depression symptoms were significantly lower. Included trials varied widely in treatment and injury characteristics. The certainty of evidence was low or very low for most effects and heterogeneity moderate to substantial. Most studies had risk of bias domains judged to be high or unclear. Owing to very low certainty of results, we are unsure whether psychological therapies reduce pain and functional impairment after musculoskeletal injury; they may result in improved depression immediately posttreatment and at follow-up. More research is needed to identify treatments that result in enduring effects. [ABSTRACT FROM AUTHOR]

Background and Purpose. Fear of movement is a risk factor for poor post-operative outcomes in patients following spine surgery. The purposes of this case series were: (1) to describe the effects of a cognitive-behavioral–based physical therapy (CBPT) intervention in patients with high fear of movement following lumbar spine surgery and (2) to assess the feasibility of physical therapists delivering cognitive-behavioral techniques over the telephone. Case Description. Eight patients who underwent surgery for a lumbar degenerative condition completed the 6-session CBPT intervention. The intervention included empirically supported behavioral self-management, problem solving, and cognitive restructuring and relaxation strategies and was conducted in person and then weekly over the phone. Patient-reported outcomes of pain and disability were assessed at baseline (6 weeks after surgery), post-intervention (3 months after surgery), and at follow-up (6 months after surgery). Performance-based outcomes were tested at baseline and post-intervention. The outcome measures were the Brief Pain Inventory, Oswestry Disability Index, 5-Chair Stand Test, and 10-Meter Walk Test. Outcomes. Seven of the patients demonstrated a clinically significant reduction in pain, and all 8 of the patients had a clinically significant reduction in disability at 6-month follow-up. Improvement on the performance-based tests also was noted post-intervention, with 5 patients demonstrating clinically meaningful change on the 10-Meter Walk Test. Discussion. The findings suggest that physical therapists can feasibly implement cognitive-behavioral skills over the telephone and may positively affect outcomes after spine surgery. However, a randomized clinical trial is needed to confirm the results of this case series and the efficacy of the CBPT intervention. Clinical implications include broadening the availability of well-accepted cognitive-behavioral strategies by expanding implementation to physical therapists and through a telephone delivery model. [ABSTRACT FROM AUTHOR]

Background: The number of people surviving critical illness is rising rapidly around the globe. Survivorship comes at a cost, with approximately half of patients with acute respiratory failure (ARF) experiencing clinically significant symptoms of anxiety, and 32–40% of survivors having substantial anxiety symptoms in the months or years after hospitalization. Methods: This feasibility study reports on 11 consecutive ARF patients receiving up to six sessions of a psychological intervention for self-management of anxiety. Results: All 11 patients accepted and received the psychological intervention. Four patients did not fully complete all 6 sessions due to death (n = 1, 2 sessions completed), and early hospital discharge (n = 3, patients completed 2, 3 and 5 sessions). The median (IQR) score (range: 0–100; minimal clinically important difference: 13) for the Visual Analog Scale-Anxiety (VAS-A) pre-intervention was 70 (57, 75) points. During the intervention, all 11 patients had a decrease in VAS-A, with a median (IQR) decrease of 44 (19, 48) points. Conclusions: This self-management intervention appears acceptable and feasible to implement among ARF patients during and after an ICU stay. [ABSTRACT FROM AUTHOR]

Purpose: To determine feasibility and acceptability of a telephone‐based Cognitive‐Behavioral‐Based Physical Therapy program for patients following traumatic lower extremity injury (CBPT‐Trauma). Methods: Patients were screened for high psychosocial risk factors and then completed the 6‐week CBPT‐Trauma program. Physical function, pain, and psychosocial outcomes were assessed at baseline and 6‐months follow‐up. Descriptive statistics assessed change in outcomes. Results: Recruitment rate was 59%. Twenty‐seven patients (73%) had a high psychosocial risk profile. Twelve patients completed the program and the follow‐up assessment at 6 months and found the program to be very or extremely helpful to their overall recovery. All demonstrated a clinically meaningful increase in physical function. Six patients demonstrated a clinically relevant decrease in pain intensity, pain catastrophizing, and fear of movement. Seven patients reported a clinically meaningful increase in pain self‐efficacy. Discussion: Findings suggest that recruitment is feasible for CBPT‐Trauma program. However, engagement in the CBPT‐Trauma study was low. For those that completed the program, patients were satisfied with the CBPT‐Trauma program and experienced meaningful improvement in psychosocial factors and patient‐reported outcomes. This open pilot study highlights the importance of targeted treatment for patients at high‐risk for poor outcomes and the potential for increased access to services through telephone‐delivery. [ABSTRACT FROM AUTHOR]

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 in three studies for function/disability, two for pain or quality of life, and four for psychological factors. Conclusion: When examining postoperative effects, there is no clear superiority of PIPT after surgery. However, the data illustrate potential for further development of PIPT in the context of surgery. [ABSTRACT FROM AUTHOR]

This randomized controlled trial investigated the effectiveness of an online self-management program, "Take Charge of Burn Pain (TCBP)," for 96 individuals living with chronic burn pain. Participants were randomly assigned to either the 7-week TCBP program integrating cognitive-behavioral therapy techniques, pain education, and self-management strategies or an attention control group focused on general burn recovery information. Assessments conducted at baseline, post-treatment, and 2- and 5-month follow-ups included measures of pain severity, pain interference, pain self-efficacy, posttraumatic stress disorder symptoms, and depression. Compared to the control group, participants in the TCBP program demonstrated greater reductions in pain severity (mean difference: −1.24, 95 % CI: −1.93 to −0.55, p = 0.0007) and pain catastrophizing (mean difference: −5.41, 95 % CI: −10.33 to −0.49, p = 0.0318) post-treatment when adjusting for key variables. At the two-month follow-up, the TCBP group showed significant improvements in pain interference (P = 0.0123), self-efficacy (P = 0.0269), functional abilities (P = 0.0014), and social role participation (P = 0.0498) compared to the control group. Treatment effects were not sustained at 5-month follow-up. Participants in both groups reported high levels of satisfaction with the online intervention, with the majority finding the program helpful and easy to use, and being willing to recommend it to others with pain. Findings suggest preliminary support for short-term benefits of TCBP for managing certain facets of chronic burn pain. This underscores the need to refine digital approaches to maintain and promote long-term improvements. The potential of self-guided online psychological interventions to enhance pain coping strategies for burn survivors persists. • Online self-management intervention for chronic burn pain reduces pain severity and catastrophizing short-term. • Improvements in pain interference, function, and self-efficacy at 2 months. • High participant satisfaction with online platform despite retention challenges. • Digital interventions offer potential for accessible burn pain management. [ABSTRACT FROM AUTHOR]

Reduced length of stays for inpatient rehabilitation challenge psychologists to develop new models of psychosocial service. Crisis intervention is a useful model that can be adapted to meet the needs of stroke patients and their families. The authors describe a 1-session intervention, utilizing crisis intervention and psychoeducational and cognitive behavioral techniques with stroke survivors and primary family caregivers in the inpatient rehabilitation setting. A case study illustrates the process and potential benefits of this approach. The intervention is feasible within the confines of the inpatient setting and well tolerated by participants. A controlled trial is necessary to establish the broad efficacy of this intervention. [ABSTRACT FROM AUTHOR]