Physiotherapy informed by Acceptance and Commitment Therapy for chronic low back pain: A mixed‐methods treatment fidelity evaluation
Open accessAbstract
Objectives: A randomized controlled trial of a new type of Physiotherapy informed by Acceptance and Commitment Therapy (PACT), found that it improved functioning in people with chronic low back pain compared to usual physiotherapy care. Fidelity evaluation is necessary to understand trial processes and outcomes. This study evaluated PACT treatment fidelity including delivery, receipt, and enactment. Design: A mixed‐methods study nested within a randomized controlled trial was conducted. Methods: A total of 72 (20% of total) PACT treatment audio files were independently assessed by two raters, according to a novel framework developed to measure PACT treatment content adherence, therapeutic alliance, ACT competence, and treatment enactment. Interview transcripts from 19 trial participants randomized to PACT were analysed thematically for evidence of treatment receipt and enactment. Results: PACT physiotherapists delivered treatment as intended with high content adherence and satisfactory therapeutic alliance, but ACT competence was low. Qualitative findings indicated participant receipt of 11/17 and enactment of 3/17 components; 89% ( n = 17) and 47% ( n = 9) of participants reported treatment receipt and enactment of at least one component, respectively. Conclusions: This mixed‐methods study of PACT treatment demonstrated high fidelity reflecting treatment content delivery and receipt, and therapeutic alliance. There was some evidence of treatment enactment in participants with chronic low back pain. Low ACT competence could be addressed through additional support and adaptations to therapeutic processes for delivery by physiotherapists.
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The compliance rate is higher than that in a study of Acceptance and Commitment Therapy for cancer survivors (70%) but lower than that in a study of chronic lower back pain (80%).
“However, it is higher compared to a study investigating Acceptance and Commitment Therapy for cancer survivors (70%), 12 but lower than a study examining this therapy for people with chronic lower back pain (80%). 13”
From Acceptance and Commitment Therapy is feasible for people with acquired brain injury: A process evaluation of the BrainACT treatment. (2024) · cites this paper as [13]
The Results section on PACT intervention content uses 80% as a threshold for treatment-delivery fidelity, not as a patient compliance rate. The Abstract’s Results instead report that 89% of participants received at least one component and 47% enacted at least one; neither is an 80% compliance rate for people with chronic low back pain. No page number is provided in our copy. (LLM, conf=0.87)
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- Authors
- Galea Holmes, M. N., Wileman, V., Hassan, S., Denning, J., Critchley, D., Norton, S., McCracken, L. M., & Godfrey, E.
- Affiliations
- Health Psychology Section Department of Psychology Institute of Psychiatry, Psychology and Neuroscience (IoPPN) King's College London UK
- King's College London (GB)
- Corresponding author
- Wileman, Vari
- ORCID
- Venue
- British Journal of Health Psychology
- Publisher
- Wiley
- Published
- 2022-02-03
- Volume
- 27
- Issue
- 3
- Pages
- 935-955
- ISSN
- 1359-107X (ISSN-L)
- 2044-8287
- PMC
- PMC9540449
- OpenAlex
- W4210735840
- Cited by
- 13
- References
- 44
- Citations by year
- 2026: 4 · 2025: 1 · 2024: 3 · 2023: 4 · 2022: 1
- FWCI
- 1.35
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- British Journal of Health Psychology (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research Portal (King's College London) (publishedVersion, cc-by)
- Uppsala University Publications (Uppsala University) (submittedVersion, other-oa)
- UCL Discovery (University College London) (submittedVersion)
- Queen Mary Research Online (Queen Mary University of London) (submittedVersion, other-oa)
- Funders
- Research for Patient Benefit Programme (PB‐PG‐1112‐29055)
- Topics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Keywords
- physiotherapy, acceptance and commitment therapy, chronic low back pain, intervention fidelity, therapeutic relationship, treatment receipt
- MeSH terms
- Humans, Low Back Pain, Physical Therapy Modalities, Chronic Pain, Physical Therapists, Acceptance and Commitment Therapy
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