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

Beneciuk, Jason M.; George, Steven Z.; Greco, Carol M.; Schneider, Michael J.; Wegener, Stephen T.; Saper, Robert B.; Delitto, Anthony

doi:10.1186/s13063-019-3350-3

Cited by 43Musculoskeletal pain and rehabilitationHealth Policy Implementation ScienceInnovations in Medical Education

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

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Beneciuk, Jason M., George, Steven Z., Greco, Carol M., Schneider, Michael J., Wegener, Stephen T., Saper, Robert B., Delitto, Anthony·2019·Trials

DOI 10.1186/s13063-019-3350-3PMC PMC6501335

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Abstract

BACKGROUND: Low back pain (LBP) is a public health concern because it is highly prevalent and the leading cause of disability worldwide. Psychologically informed physical therapy (PIPT) is a secondary prevention approach that first aims to identify individuals at high risk for transitioning to chronicity and then provides tailored treatment to reduce that risk. Training models that are feasible to implement with acceptable training quality are needed to improve scalability for widespread implementation of PIPT. This manuscript describes the PIPT training program that was developed for training physical therapists providing PIPT in the TARGET trial. METHODS: The PIPT training program was developed, tested, and modified using an iterative process. Content development consisted of stakeholder engagement, beta testing, modification of training, and confirmation of final course objectives. Methods of delivery consisted of a website that included brief online educational modules followed by a live 8-h workshop that included video-based mock case scenarios and case-based role playing. Attitudes, beliefs, and confidence in implementing PIPT principles were assessed before and immediately after training to measure training quality and impact. RESULTS: Early stakeholder engagement and beta testing indicated the need for increased emphasis on experiential learning opportunities and patient-centered communication training. Booster training varied extensively across TARGET sites with involvement of 'clinician champions' providing brief follow-up sessions identified as best practice. Favorable post-training changes in physical therapist attitudes and beliefs toward biopsychosocial treatment orientation and increased confidence in implementing PIPT principles were observed. CONCLUSIONS: PIPT training for provider participation in the TARGET trial was feasible to deliver. Course content was acceptable to physical therapists and resulted in improved beliefs and confidence in applying PIPT skills during clinical practice. Ongoing consultation and site-based continuing education were methods by which specific TARGET sites maintained or augmented PIPT skill training; however, implementing ongoing training was challenging in general. Due to the pragmatic nature of the TARGET trial, it was not possible to directly measure the effect of PIPT training on treatment fidelity, which was a limitation of our approach. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02647658 . Registered on 6 January 2016.

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The success of delivery of PiPT and PNE has been shown to be impacted by the PT's confidence and comfort with the program as well as the therapist having the qualities necessary to implement patient-centered care.
“The success of delivery of PiPT and PNE has been shown to be impacted by the PT’s confidence and comfort with the program as well as the therapist having the qualities necessary to implement patient-centered care.20,28,32,35,44,52”
From Remotely Delivered Psychologically Informed Mindful Movement Physical Therapy for Pain Care: A Framework for Operationalization (2023) · cites this paper as [35]
The Results section (Confidence in PIPT skill application; page unavailable) reports increased therapist confidence after training, and the Discussion (Patient-centered communication; page unavailable) says communication training appears important for integrating PIPT into practice. But the Discussion (Provider training; page unavailable) says further assessment is needed to determine whether training changed provider behavior. The paper does not show that confidence, comfort, or therapist qualities affected the success of delivering PIPT or PNE. (LLM, conf=0.87)
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“22,31,32,34,35 31-34 The lack of clear competencies, rationale, framework, and clinical models that are feasible and acceptable make it dif ﬁ cult to develop, adopt, and apply best practices for the spread and adoption of PiPT programs.”
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Study protocol for targeted interventions to prevent chronic low back pain in high-risk patients: A multi-site pragmatic cluster randomized controlled trial (TARGET Trial)
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Authors: Beneciuk, J. M., George, S. Z., Greco, C. M., Schneider, M. J., Wegener, S. T., Saper, R. B., & Delitto, A.
Affiliations: University of Florida Health (US)
Duke University (US)
University of Pittsburgh (US)
Johns Hopkins University (US)
Boston Medical Center (US)
Corresponding author: Beneciuk, Jason M.
ORCID: Beneciuk, Jason M.
George, Steven Z.
Greco, Carol M.
Schneider, Michael J.
Wegener, Stephen T.
Saper, Robert B.
Delitto, Anthony
Venue: Trials
Publisher: Springer Science and Business Media LLC
Published: 2019-05-06
Volume: 20
Issue: 1
Pages: 256-256
ISSN: 1745-6215 (ISSN-L)
DOI: 10.1186/s13063-019-3350-3
PMC: PMC6501335
OpenAlex: W2947090425
Cited by: 43
References: 49
Citations by year: 2026: 4 · 2025: 5 · 2024: 9 · 2023: 7 · 2022: 5 · 2021: 5 · 2020: 7 · 2019: 1
FWCI: 2.79
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by
creativecommons.org/licenses/by/4.0/ (tdm)
Locations: Trials (publishedVersion, cc-by)
Research Square (acceptedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders: Patient-Centered Outcomes Research Institute (PCS-1402-10867)
Topics: Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Innovations in Medical Education
Keywords: low back pain, chronic low back pain, physiotherapy education, secondary prevention, biopsychosocial care, stakeholder engagement, online learning modules, role play, booster training, TARGET trial
MeSH terms: Adult, Attitude of Health Personnel, Curriculum, Education, Professional, Humans, Health Knowledge, Attitudes, Practice, Middle Aged, Risk Factors, United States, Low Back Pain, Disease Progression, Risk Assessment, Patient-Centered Care, Physical Therapy Modalities, Secondary Prevention, Chronic Pain, Acute Pain, Physical Therapists

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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

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