Implementation of Psychologically Informed Physical Therapy for Low Back Pain: Where Do We Stand, Where Do We Go?

Ballengee, Lindsay A; Zullig, Leah L; George, Steven Z

doi:10.2147/jpr.s311973

Cited by 46Musculoskeletal pain and rehabilitationHealth Policy Implementation ScienceMedical Practices and Rehabilitation

Implementation of Psychologically Informed Physical Therapy for Low Back Pain: Where Do We Stand, Where Do We Go?

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Ballengee, Lindsay A, Zullig, Leah L, George, Steven Z·2021·Journal of Pain Research

DOI 10.2147/jpr.s311973PMC PMC8665872

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Abstract

Low back pain continues to be a leading cause of disability and cost throughout the world. Evidence-based guidelines recommend use of non-pharmacological interventions to address decreases in physical function due to low back pain. Psychologically informed physical therapy (PIPT) is one way to effectively and efficiently address the need for non-pharmacological approaches. However, adoption of psychologically informed practice (PiP) by physical therapists has shown mixed results due to implementation challenges. In this perspective, we discuss the current state of PIPT training and implementation. We also propose a conceptual roadmap for future implementation needs related to increasing delivery of PIPT-informed approaches.

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Typical components of PiPT interventions include some combination of education, cognitive-behavioral techniques for addressing coping strategies and responses to pain, and practices that influence psychophysiology such as body awareness and mindful movement.
“Typical components of PiPT interventions include some combination of education, cognitive-behavioral techniques for addressing coping strategies and responses to pain, and practices that influence psychophysiology such as body awareness and mindful movement.31-34”
From Remotely Delivered Psychologically Informed Mindful Movement Physical Therapy for Pain Care: A Framework for Operationalization (2023) · cites this paper as [31]
The Introduction (page unavailable) identifies educational, cognitive-behavioral (cognition and coping skills), and psychophysiological (stress reduction and mindfulness) approaches as types of psychologically informed intervention, and defines PIPT as their delivery by physical therapists. Its examples include mindfulness and exercise, but it does not identify body awareness or mindful movement as intervention components. (LLM, conf=0.86)
Experimental — accuracy not yet measured
The lack of clear competencies, rationale, framework, and clinical models that are feasible and acceptable makes it difficult to develop, adopt, and apply best practices for the spread and adoption of PiPT programs.
“The lack of clear competencies, rationale, framework, and clinical models that are feasible and acceptable make it difficult to develop, adopt, and apply best practices for the spread and adoption of PiPT programs.22,23,31,33,36”
From Remotely Delivered Psychologically Informed Mindful Movement Physical Therapy for Pain Care: A Framework for Operationalization (2023) · cites this paper as [31]
In 'Concept 1: Current State of PIPT Implementation,' the paper says there is no consensus on optimal training delivery or how to increase uptake in health systems. 'Moving Towards Wide-Scale Implementation' likewise says there is no overarching guidance for increasing real-world delivery. These passages support the implementation difficulty, but do not establish a lack of clear competencies, rationale, or feasible and acceptable clinical models; the paper describes existing conceptual models and proposes an implementation roadmap. (LLM, conf=0.82)
Experimental — accuracy not yet measured
Psychologically informed physical therapy programs help physical therapists integrate emotional and cognitive components of care and are advantageous to implementation of interdisciplinary programs.
“The development of psychologically informed physical therapy (PiPT) programs help physical therapists integrate emotional/cognitive components of care and is advantageous to implementation of interdisciplinary programs.22,29-31”
From Remotely Delivered Psychologically Informed Mindful Movement Physical Therapy for Pain Care: A Framework for Operationalization (2023) · cites this paper as [31]
The Introduction (page unavailable) defines PIPT as physical therapists integrating physical treatment with cognitive-behavioral treatment, supporting the emotional and cognitive care component. It says other providers use psychologically informed approaches but are not the paper’s focus. The cited passages do not establish that PIPT programs facilitate implementation of interdisciplinary programs. (LLM, conf=0.85)
Experimental — accuracy not yet measured
Challenges to implementation and delivery of PiPT include wide variability in programs with no clear rationale or framework for inclusion or exclusion of specific components.
“Challenges to implementation and delivery of PiPT include wide variability in programs with no clear rationale or framework for inclusion, or exclusion, of specific components.22,31-34”
From Remotely Delivered Psychologically Informed Mindful Movement Physical Therapy for Pain Care: A Framework for Operationalization (2023) · cites this paper as [31]
The “Concept 1: Current State of PIPT Implementation” section describes differences among PIPT training programs and says there is no consensus on their optimal delivery. It also identifies shared core training components; it does not say that PiPT programs lack a rationale or framework for including or excluding specific components. (LLM, conf=0.84)
Experimental — accuracy not yet measured
The inclusion of patient-centered communication, such as motivational interviewing, aids in supporting a healthy therapeutic alliance and self-efficacy for change.
“The inclusion of patient centered communication (e.g. motivational interviewing) aid in supporting a healthy therapeutic alliance and self-efficacy for change.31-34”
From Remotely Delivered Psychologically Informed Mindful Movement Physical Therapy for Pain Care: A Framework for Operationalization (2023) · cites this paper as [31]

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[9]Ballengee LA, George SZ. Towards a better understanding of psychologically informed practice for physical therapists. In: Lifestyle Medicine for the Physical Therapist. In press
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Authors: Ballengee, L. A., Zullig, L. L., & George, S. Z.
Affiliations: Duke University (US)
Corresponding author: Ballengee, Lindsay A
George, Steven Z
ORCID: Ballengee, Lindsay A
Zullig, Leah L
George, Steven Z
Venue: Journal of Pain Research
Publisher: Informa UK Limited
Published: 2021-12
Volume: Volume 14
Pages: 3747-3757
ISSN: 1178-7090 (ISSN-L)
DOI: 10.2147/jpr.s311973
PMC: PMC8665872
OpenAlex: W4200098355
Cited by: 46
References: 52
Citations by year: 2026: 11 · 2025: 9 · 2024: 9 · 2023: 14 · 2022: 3
FWCI: 0.82
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by-nc
creativecommons.org/licenses/by-nc/3.0/ (unspecified)
Locations: Journal of Pain Research (publishedVersion, cc-by-nc)
PubMed Central (publishedVersion, cc-by-nc)
PubMed (publishedVersion)
Dove Medical Press (Taylor and Francis Group) (submittedVersion, cc-by-sa)
Funders: Pharmaceutical Research and Manufacturers of America Foundation
Pfizer
National Institutes of Health
Topics: Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Medical Practices and Rehabilitation
Keywords: low back pain, psychological factors in pain, non-pharmacological treatment, implementation barriers, physiotherapy education

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Implementation of Psychologically Informed Physical Therapy for Low Back Pain: Where Do We Stand, Where Do We Go?

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