Physiotherapy informed by Acceptance and Commitment Therapy for chronic low back pain: A mixed-methods treatment fidelity evaluation.

OBJECTIVES: A randomized controlled trial of a new type of Physiotherapy informed by Acceptance and Commitment Therapy (PACT), found that it improved functioning in people with chronic low back pain compared to usual physiotherapy care. Fidelity evaluation is necessary to understand trial processes and outcomes. This study evaluated PACT treatment fidelity including delivery, receipt, and enactment. DESIGN: A mixed-methods study nested within a randomized controlled trial was conducted. METHODS: A total of 72 (20% of total) PACT treatment audio files were independently assessed by two raters, according to a novel framework developed to measure PACT treatment content adherence, therapeutic alliance, ACT competence, and treatment enactment. Interview transcripts from 19 trial participants randomized to PACT were analysed thematically for evidence of treatment receipt and enactment. RESULTS: PACT physiotherapists delivered treatment as intended with high content adherence and satisfactory therapeutic alliance, but ACT competence was low. Qualitative findings indicated participant receipt of 11/17 and enactment of 3/17 components; 89% (n = 17) and 47% (n = 9) of participants reported treatment receipt and enactment of at least one component, respectively. CONCLUSIONS: This mixed-methods study of PACT treatment demonstrated high fidelity reflecting treatment content delivery and receipt, and therapeutic alliance. There was some evidence of treatment enactment in participants with chronic low back pain. Low ACT competence could be addressed through additional support and adaptations to therapeutic processes for delivery by physiotherapists.

Evaluation of a functional restoration programme in chronic low back pain.

BACKGROUND: Persistent low back pain is a major health and socio-economic problem in the UK. Evidence-based guidelines have been produced to inform management strategies for this significant health issue. This study reports the outcome of a tertiary intervention functional restoration programme (FRP) in manual workers of a water utility company, consistent with UK guidelines. OBJECTIVES: To evaluate whether a FRP could achieve a sustainable improvement in back health, a sustainable return to full duties and a cost reduction. METHOD: Participants were assessed at start, end, 12 and 24 months post-programme. RESULTS: Eighty-nine employees completed the FRP; 78 returned to normal duties, nine to restricted duties and two left the employer shortly after. Overall, there were significant improvements in psychological status, perceived pain, disability and work capability. Improvements were sustained for 24 months. Sickness absence and the need for post-treatment work restrictions decreased. Reductions in ill-health retirements and compensation claims for low back pain were reduced. CONCLUSION: The findings support the effectiveness of a tertiary intervention FRP for workers with persistent low back pain.