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Godfrey E, Wileman V, Galea Holmes M, et al. Physical Therapy Informed by Acceptance and Commitment Therapy (PACT) Versus Usual Care Physical Therapy for Adults With Chronic Low Back Pain: A Randomized Controlled Trial. J Pain. 2019 Jun 5. pii: S1526-5900(19)30065-3. doi: 10.1016/j.jpain.2019.05.012. (Original study)
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 ACT (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 4 UK public hospitals. The Roland-Morris Disability Questionnaire (RMDQ) at 3 months' post-randomization was the primary outcome. Two hundred forty-eight 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?=?.037, 95% CI?=?-2.08 to -.07, d?=?.2), Patient Specific Functioning (p?=?.008), SF12 physical health (p?=?.032), and treatment credibility (p < .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.

Ratings
Discipline Area Score
Rehab Clinician (OT/PT) 6 / 7
Psychologist 6 / 7
Physician 5 / 7
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  Back Pain   Chronic Low Back Pain
Comments from MORE raters

Physician rater

Although this is a useful article, the results are known in clinical practice. So it's not interesting.

Physician rater

This randomised controlled trial looked at the addition of acceptance and commitment interventions to physical therapies in patients with chronic low back pain. The control group was usual care physical therapies. The outcome was the Roland Morris Disability questionnaire with the primary outcome being at 3 months. Interventions were for a relatively short period which may explain why there was a significant difference favouring the acceptance and commitment plus physical therapy group at 3 months but no difference between the two intervention groups at 12 months. Treatments for chronic low back pain are relatively ineffective so any intervention of proven efficacy would be a welcome addition to the treatment modalities available for this condition. However the benefits have to be sustainable over a long duration to be f any significant benefit to this patient group and this study has failed to demonstrate this.

Psychologist rater

As a clinical psychologist specializing in pain management, I find the results of PACT would seem to be beneficial regarding more commitment of the patients in their therapy. I agree with the authors that replication of the study is warranted.

Psychologist rater

A great barrier to chronic pain treatment is compliance. By utilizing a new method to treat chronic back pain by incorporating psychological tools in physical treatment, it may enhance the possibility of achieving positive results as motivates the sufferer and provides new techniques to the physiotherapist. PACT trial offers a new modality, with promising results good results and this is of value.

Rehab Clinician (OT/PT) rater

A good study with very sound underpinning methodology but with very disappointing results. Why despite our best efforts do some people just not improve?
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