The Development of a Cognitive Reassurance Training Program and Its Impact on Physical Therapist and Patient Outcomes
试验速览
- 阶段
- 不适用
- 状态
- 终止
- 入组人数
- 128
- 试验地点
- 1
- 主要终点
- Change in back beliefs questionnaire for health care providers
研究概览
简要总结
The focus of this proposal is to evaluate the feasibility of a cognitive reassurance training program by examining changes in physical therapist low back pain beliefs and skills with training and evaluating the quality with which physical therapists apply cognitive reassurance to patients. The secondary focus is to examine the association between physical therapist application of cognitive reassurance and short-term changes in patients' low back pain beliefs and expectations.
详细描述
Identifying strategies to favorably alter unhelpful cognitions of patients with recent onset low back pain is a research priority and could help curb the transition from acute to chronic low back pain; lessening the need for prolonged and costly management. Current evidence suggests that psychological factors, including maladaptive pain beliefs and avoidant behaviors and expectations for recovery, are associated with poor outcomes in patients with low back pain. Recently, considerable attention has been given to training non-psychologists to provide psychologically based interventions for patients with low back pian. A recent review of interventions that included psychological approaches noted that all of the trials that failed to show benefit included delivery of the intervention by non-psychologists. Authors suggest that increasing the effort in selecting, training, supervising and assessing the competence of the practitioners delivering the treatment could improve results.
Low back pain comprises approximately 50% of the caseload of outpatient physical therapists physical therapists making physical therapists ideally positioned to manage the unhelpful cognitions of patients with low back pain. However, physical therapists often feel unprepared when managing the cognitive factors associated with low back pain. The purpose of this project is to develop and assess the effectiveness of a training program for physical therapists that focuses on cognitive reassurance; a novel cognitive intervention for patients with low back pain.
Cognitive reassurance is a communication approach in which maladaptive beliefs and expectations are identified. Tailored explanations for the patient's conditions are then provided, possible prognosis and treatment are discussed, and clarifications are offered. With adequate training, physical therapists could utilize cognitive reassurance to promote patients' understanding of his/her condition and modify maladaptive low back pain-related beliefs and expectations.
The proposed pilot study will use a pre-post design to examine the impact of cognitive reassurance training on the low back pain beliefs and skills in physical therapists and physical therapist assistants. Following the training the investigators will recruit patients who have scheduled an evaluation for low back pain with the physical therapists who attended the training. Patient data will be collected at baseline before the evaluation and follow up data at 2, 4 and 8 weeks.
The specific aims are: 1) Evaluate the feasibility of a cognitive reassurance training program for physical therapists that focuses on modifying physical therapists' beliefs and improving physical therapists' skill in the application of cognitive reassurance for patients with acute/subacute low back pain. 2) Evaluate the application of cognitive reassurance by physical therapists to patients with acute/sub-acute low back pain. 3) Examine the association between physical therapist application of cognitive reassurance and short-term changes in the patient's low back pain beliefs and expectations (low back pain beliefs, self-efficacy, pain catastrophizing, fear-avoidance).
研究设计
- 研究类型
- Interventional
- 分配方式
- Na
- 干预模型
- Single Group
- 主要目的
- Health Services Research
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •Therapist inclusion criteria:
- •University of Utah Health Care physical therapists and physical therapist assistants
- •Employed at least 20 hours a week
- •Licensed in the state of Utah
排除标准
- •Patient inclusion criteria
- •Primary reason for scheduling an evaluation with a physical therapist is low back pain (defined as symptoms of pain and/or numbness between the 12th rib and buttocks with or without referral in to one or both legs
- •Current episode of low back pain ≤ 12 weeks duration
- •Age 18-64
- •Ability to read and speak English
- •Patient exclusion criteria
- •Report being referred to physical therapy for specific low back pathology (e.g. fracture)
- •Any lumbar surgery in the past 6 months
- •Current pregnancy
研究组 & 干预措施
Provider training
干预措施: Cognitive reassurance training (Other)
结局指标
主要结局
Change in back beliefs questionnaire for health care providers
时间窗: Baseline, 5 days
Measures providers' beliefs about back pain pre and post training
Low back pain vignettes
时间窗: End of 2nd day of therapist training
Measures provider decision making related to cognitive reassurance
Skills assessment
时间窗: End of 2nd day of therapist training
Assess skills in the provision of cognitive reassurance during role-playing activity
次要结局
- Change in fear the Avoidance Beliefs Questionnaire(Baseline, 4 weeks and 8 weeks)
- Change in the Pain Catastrophizing Scale(Baseline, 4 weeks and 8 weeks)
- Change in the Pain Self-efficacy Questionnaire(Baseline, 4 weeks and 8 weeks)
- Patient check list(2 weeks following initial evaluation for low back pain by a physical therapist)
- Change in the Back Beliefs Questionnaire(Baseline, 4 weeks and 8 weeks)
- Open-ended question(2 weeks following the initial evaluation for low back pain by a physical therapist)
- Provider check list(2 weeks status post initial evaluation of patient with low back pain)
研究者
Jake Magel
Research Assistant Professor
University of Utah