Abstract
The burgeoning prevalence of Low Back Pain (LBP) continues to burden public health systems worldwide. The development of psychosocial interventions alongside traditional physical therapy methods, like Psychologically Informed Physical Therapy (PIPT), offers a promising avenue to prevent the transition from acute to chronic LBP in high-risk individuals. This article provides an in-depth examination of a pragmatic training course in PIPT developed for the TARGET trial, detailing the iterative development process, content delivery, and the impact on physical therapists’ skills and attitudes. The significance of such targeted interventions in addressing the global LBP crisis is underscored.
Keywords
1. Low Back Pain
2. Psychologically Informed Physical Therapy
3. TARGET trial
4. Physical Therapists Training
5. Chronic Pain Prevention
Introduction
Low Back Pain (LBP) is not only a pervasive affliction but also the leading cause of disability across the globe, with far-reaching implications on the quality of life and economic stability. The TARGET trial represents a significant effort in the fight against the chronicity of LBP, straddling the realms of research and practical implementation of novel interventions like Psychologically Informed Physical Therapy (PIPT). This trial is indicative of a paradigm shift in LBP management, as it focuses on equipping therapists with the skills to identify and treat high-risk patients through a comprehensive PIPT training program. This article delves into the groundbreaking development and delivery of this training, assessing its feasibility, impact, and the potential to revolutionize LBP treatment protocols.
The Complications of Low Back Pain
Low Back Pain has become a modern-day epidemic, challenging healthcare systems and professionals globally. LBP’s profound impact on disability-adjusted life-years (DALYs) and its transition to chronic pain conditions in some patients necessitates innovative interventions (Global Burden of Disease 2015 Disability-Adjusted Life-Years (DALYs) and Healthy Life Expectancy (HALE) Collaborators, 2016; Global Burden of Disease 2015 Disease and Injury Incidence and Prevalence Collaborators, 2016). Understanding and targeting the psychosocial factors associated with poor prognosis, such as pain catastrophizing and fear avoidance beliefs, have been recognized as integral in LBP management (Wertli MM, Eugster R, et al., 2014; Wertli MM, Rasmussen-Barr E, et al., 2014).
The Pursuit of Preventative Measures
The TARGET trial – a multicenter, pragmatic clinical trial – set its sights on preventing the chronicity of LBP through targeted intervention. Though prevention strategies have garnered attention, it became clear that professionals needed appropriate training to implement these practices effectively. Psychologically informed interventions place emphasis not only on the physiological aspects of back pain but also on the psychological and social factors that contribute to its persistence (Chou R, Shekelle P., 2010).
The Development of a Novel Training Program
The PIPT training program for the TARGET trial was born out of a rigorous development process, informed by stakeholder engagement, beta testing, training modifications, and detailed content confirmation (Beneciuk Jason M, et al., 2019). The finalized course objective was to deliver a multifaceted training model that was feasible for wide-scale implementation. Central to this model was a website hosting educational modules coupled with an 8-hour workshop featuring role-plays and video case studies.
Measuring the Impact on Physical Therapists
The transition to PIPT represented a challenging yet necessary evolution in treatment paradigms for physical therapists. To evaluate the training’s impact, therapists’ attitudes, beliefs, and confidence were gauged before and after course completion. Post-training, therapists expressed significantly improved biopsychosocial treatment orientations and greater confidence in applying their newfound PIPT skills to clinical practice (Beneciuk Jason M, et al., 2019).
Challenges of Implementing Continuing Education
Despite the positive outcomes, maintaining PIPT proficiency beyond the initial training posed considerable challenges. “Clinician champions” offering booster sessions emerged as a best practice, but consistency in continued education presented difficulties across different sites, demonstrating a broader challenge within the healthcare industry for ongoing professional development (Beneciuk Jason M, et al., 2019).
Implications for Future Training and Practice
The TARGET trial PIPT training has illuminated a path forward for physical therapy—interventions grounded in psychological and social understanding are not only possible but also capable of engendering a more effective treatment landscape for LBP. However, improvements in fidelity to the training need to be addressed going forward (Beneciuk Jason M, et al., 2019).
Conclusion
The TARGET trial has set a precedent for the incorporation of PIPT in mitigating the risk of chronicity in LBP cases. The trial’s training regimen has demonstrated feasibility and efficacy, yielding a significant shift in the therapeutic community’s approach to LBP. While the road ahead may be complex, with challenges in maintaining the continuum of training and practice, the TARGET trial offers a beacon of hope for millions afflicted with LBP—presenting a model that blurs the lines between physical impairment and psychological distress and promotes a more holistic, patient-centered approach to back pain management. As the therapeutic landscape evolves, it’s crucial to realize the TARGET’s potential trial’s implications for global healthcare frameworks and the necessity of scaled-up training initiatives for sustainable healthcare progress.
References
1. Global Burden of Disease 2015 Disability-Adjusted Life-Years (DALYs) and Healthy Life Expectancy (HALE) Collaborators. (2016). Global, regional, and national disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388(10053):1603–1658. DOI: 10.1186/s13063-019-3350-3
2. Beneciuk Jason M, et al. (2019). 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. Trials, 20(1), 256. DOI: 10.1186/s13063-019-3350-3
3. Wertli MM, Eugster R, et al. (2014). Catastrophizing—a prognostic factor for outcome in patients with low back pain: a systematic review. Spine J. 14(11):2639–2657.
4. Chou R, Shekelle P. (2010). Will this patient develop persistent disabling low back pain? JAMA. 303(13):1295–1302.
5. Global Burden of Disease 2015 Disease and Injury Incidence and Prevalence Collaborators. (2016). Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388(10053):1545–1602. DOI: 10.1186/s13063-019-3350-3
DOI:
10.1186/s13063-019-3350-3