Psychologically informed physical therapy for musculoskeletal pain: current approaches, implications, and future directions from recent randomized trials

Review written by Robin Kerr info

Key Points

  1. Recent randomized trials have examined the efficacy of Psychologically Informed Physical Therapy (PIPT) compared to standard physical therapy approaches in patients with musculoskeletal pain.
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BACKGROUND & OBJECTIVE

Psychological factors are accepted as playing a major role in disability and persistent pain outcomes. Multidisciplinary team management has been found to be more effective than physiotherapy alone in persistent pain management due to targeting of maladaptive cognitions, emotions and behaviours (1). However, access to multidisciplinary care can be limited for some due to financial and demographic reasons. Therefore, Psychologically Informed Physical Therapy (PIPT) has been proposed.

PIPT involves the application of psychological strategies (such as Cognitive Behavioral Therapy (CBT), graded exposure, and Acceptance and Commitment Therapy (ACT)) within a physiotherapy treatment, in an attempt to improve outcomes. The initial shift towards PIPT was initially reflected in the development of the STarT Back interventions (2,3).

There have been several randomized controlled trials examining the efficiency of PIPT versus traditional physiotherapy treatment in the management of musculoskeletal disorders (4). This paper adds to the body of knowledge with a review of the most recent research.

Multidisciplinary team management has been found to be more effective than physiotherapy alone in persistent pain management.
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There are practical considerations such as extensive training demands and implementation challenges that may impact upon the uptake and delivery of PIPT.

METHODS

RCTs published after 2012 looking at the efficacy of PIPT were scored via the PEDro scale for quality. The PIPT interventions, methods and outcome findings were then summarized. The selected studies:

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