University of Florida, College of Public Health & Health Professions, Department of Physical Therapy, Box 100154, UFHSC, Gainesville, FL 32610-0154, USA; Brooks Rehabilitation Clinical Research Center, 3901 University Blvd. South, Suite 103, Jacksonville, FL 32216, USA.
Department of Orthopaedic Surgery, Duke University, 2200 W. Main Street, Suite B-230, Durham, NC 27705, USA.
Musculoskelet Sci Pract. 2019 Jun;41:36-42. doi: 10.1016/j.msksp.2019.03.004. Epub 2019 Mar 19.
Psychologically Informed Physical Therapy (PIPT) aims to identify individuals at high risk for transitioning to chronicity and merge impairment-focused physical therapy with cognitive behavioral therapy principles. Treatment monitoring is an important part of PIPT and involves identifying changes in clinical measures to inform clinical decision making.
The purpose of this case series is to describe treatment monitoring using psychological and physical impairment measures for patients identified as 'high-risk' for persistent low back pain (LBP) related disability.
Secondary analysis of patients (n = 23) identified as 'high-risk' using the STarT Back Tool and enrolled in two-phased, sequential study that evaluated feasibility and generated preliminary PIPT treatment effects for 4-week clinical outcomes.
Physical therapists (n = 5) used psychological [Fear-Avoidance Beliefs Questionnaire (FABQ-PA, FABQ-W), Tampa Scale for Kinesiophobia (TSK-11), Pain Catastrophizing Scale (PCS) and Fear of Daily Activities Questionnaire (FDAQ)] and the Physical Impairment Index (PII) measures for PIPT treatment monitoring. Clinical outcome measures [Numerical Pain Rating Scale (NPRS), Oswestry Disability Index (ODI)] were administered at intake and 4-weeks later. Linear regression models evaluated independent contribution of intake and 4-week changes in psychological measures and PII scores as predictors of 4-week NPRS and ODI scores.
FABQ-PA and PCS changes provided largest contributions to prediction of 4-week ODI scores. Treatment monitoring measures did not explain additional variability in 4-week NPRS scores after baseline scores were considered.
For patients at high risk for persistent LBP psychological measures consistently performed better as treatment monitoring variables compared to physical impairment measures. Treatment monitoring for PIPT with psychological measures provides opportunities to refine prediction of disability outcomes. Findings from this exploratory case series should be interpreted with caution based on its small sample size and lack of statistical power which prohibits definitive conclusions to be made on any of the treatment monitoring measures.
心理信息物理治疗（PIPT）旨在识别有向慢性转化高风险的个体，并将以损伤为重点的物理治疗与认知行为治疗原则相结合。治疗监测是 PIPT 的一个重要组成部分，涉及识别临床指标的变化，为临床决策提供信息。
本病例系列的目的是描述使用心理和身体损伤指标对被认为有持续腰痛（LBP）相关残疾高风险的患者进行治疗监测。
使用 STAR 背侧工具识别出的患者（n=23）进行二次分析，并纳入两阶段、序贯研究，评估了 4 周临床结局的可行性，并产生了初步的 PIPT 治疗效果。
物理治疗师（n=5）使用心理测量（害怕回避信念问卷（FABQ-PA、FABQ-W）、坦帕运动恐惧量表（TSK-11）、疼痛灾难化量表（PCS）和日常活动恐惧问卷（FDAQ））和物理损伤指数（PII）测量进行 PIPT 治疗监测。在摄入时和 4 周后分别进行临床结局测量（数字疼痛评分量表（NPRS）、Oswestry 残疾指数（ODI））。线性回归模型评估了摄入时和 4 周时心理测量和 PII 评分变化对 4 周时 NPRS 和 ODI 评分的独立贡献。
FABQ-PA 和 PCS 的变化对预测 4 周 ODI 评分的贡献最大。考虑到基线评分后，治疗监测措施并未解释 4 周 NPRS 评分的额外可变性。
对于持续 LBP 高风险的患者，与身体损伤指标相比，心理测量作为治疗监测变量的性能始终更好。使用心理测量进行 PIPT 治疗监测为残疾结局预测提供了机会。由于样本量小且缺乏统计能力，本探索性病例系列的结果应谨慎解释，因此无法对任何治疗监测措施做出明确结论。
