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.
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.
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.
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