Treatment monitoring as a component of psychologically informed physical therapy: A case series of patients at high risk for persistent low back pain related disability.

BACKGROUND: 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. OBJECTIVES: 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. DESIGN: 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. METHOD: 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. RESULTS: 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. CONCLUSIONS: 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.