Physical therapy informed by Acceptance and Commitment Therapy (PACT) may reduce short-term but not long-term disability compared with standard treatment in patients with chronic low back pain (CLBP), according to a study published in the Journal of Pain.

PACT is a brief physical therapist-delivered intervention that incorporates “third-wave” cognitive behavioral therapy, which focuses on improving functioning through acceptance, mindfulness strategies, and values-based action.

Related Articles

The study included 248 participants with CLBP (duration, ≥12 weeks; mean duration, 3 years) who were recruited from physical therapy clinics in 4 public hospitals in the United Kingdom. Participants were randomly assigned to receive PACT or standard care physical therapy. PACT consisted of two 60-minute face-to-face sessions 2 weeks apart, taking place in a private room, plus one 20-minute telephone call 1 month after the last in-person session.

Continue Reading

A total of 219 participants (88.3%) completed measures at 3 and/or 12 months of follow-up.

At 3 months, participants in the PACT group reported better outcomes for disability evaluated with the Roland Morris Disability Questionnaire (mean score difference, 1.07; P =.037; 95% CI, -2.08 to -0.07), for functioning, assessed with the Patient Specific Functioning tool (P =.008), in physical health evaluated with the Short-Form 12 physical health questionnaire (P =.032), and for treatment credibility, compared with patients receiving standard treatment (P <.001). At the 12-month follow-up, there were no significant differences between treatment groups. Physical therapists were found to successfully incorporate PACT into treatment, with a high fidelity for treatment delivery (≥80%).

“More research is warranted to develop successful care in the long term and to determine whether PACT is effective and cost-effective in a larger trial,” the researchers noted.

Follow @ClinicalPainAdv


Godfrey E, Wileman V, Holmes MG, et al. Physical therapy informed by Acceptance and Commitment Therapy (PACT) versus usual care physical therapy for adults with chronic low back pain: a randomised controlled trial. [published online June 4, 2019]. J Pain. doi:10.1016/j.jpain.2019.05.012