Practice Changes 6 Months Following a Physical Therapist Training Program Regarding Opioid Use and Misuse Screening and Assessment: A Qualitative Study.

Background: The U.S. Preventive Services Task Force recommends that all healthcare providers be trained to screen for misuse and/or opioid use disorder.

PT-IN-MIND: study protocol for a multisite randomised feasibility trial investigating physical therapy with integrated mindfulness (PT-IN-MIND) for patients with chronic musculoskeletal pain and long-term opioid treatment who attend outpatient physical therapy.

Introduction: Many individuals receiving outpatient physical therapy have musculoskeletal pain and up to one-third use prescription opioids. The impact of physical therapist-led mindfulness-based interventions integrated with evidence-based physical therapy (I-EPT) to manage patients with chronic musculoskeletal pain and long-term opioid treatment has not been elucidated. This project evaluates the feasibility of conducting a cluster randomised trial to test the effectiveness of I-EPT.

Psychological Constructs From the Fear Avoidance Model and Beyond as Predictors for Persisting Symptoms After Concussion: An Integrative Review.

Objectives: To identify the range of evidence for relationships between psychological factors using the Fear Avoidance Model (FAM) as a guiding framework and relevant clinical outcomes in adult patients with persisting symptoms after concussion (PSaC), develop a comprehensive understanding of psychological factors that have been identified as predictors of clinical outcomes for PSaC, and contribute to the theoretical framework of the FAM for PSaC.

Data Sources: Six databases (CINAHL, Embase, PsycINFO, PubMed, SportDiscus, and Web of Science) were searched by a librarian for empirical and theoretical publications and experimental and quasi-experimental study designs. The literature search was not limited by publication date restrictions.

Emergency Department Discharge Teaching Interventions: A Scoping Review.

Introduction: Emergency department discharge education is intended to provide patients with information to self-manage their condition or injury, identify potential complications, and follow-up or referral. However, most patients cannot recall the discharge information provided, leading to adverse clinical outcomes, return visits, and higher costs. A scoping review was undertaken to explore discharge education interventions that have been studied in the emergency department setting and outcomes that have been used to evaluate the effectiveness of the interventions.

Validation of the Keele STarT MSK Tool for Patients With Musculoskeletal Pain in United States-based Outpatient Physical Therapy Settings.

The STarT MSK tool was developed to enable risk stratification of patients with common musculoskeletal (MSK) pain conditions and help identify individuals who may require more targeted interventions or closer monitoring in primary care settings, however, its validity in U.S.-based outpatient physical therapy settings has not been investigated.

A Cluster Analysis of Initial Primary Care Orders for Patients with Acute Low Back Pain.

Purpose: Primary care physicians (PCPs) often face a complex intersection of patient expectations, evidence, and policy that influences their care recommendations for acute low back pain (aLBP). The purpose of this study was to elucidate patterns of PCP orders for patients with aLBP, identify the most common patterns, and describe patient clinical and demographic characteristics associated with patterns of aLBP care.

Methods: This prospective cohort study included 9574 aLBP patients presenting to 1 of 77 primary care practices in 4 geographic locations in the United States.

Virtual Rehabilitation and COVID-19: Varied Adoption and Satisfaction Among Patients and Providers Participating in a Multi-Site Survey Study.

The COVID-19 pandemic compelled rapid healthcare adaptations including increased use of telehealth (TH) and virtual care (VC) to provide rehabilitation services. This multi-site cross-sectional survey study examined rehabilitation patients' and providers' experiences with service delivery during the COVID-19 pandemic, including the use of TH/VC. Patients and providers who received or provided rehabilitation services were recruited from 1 of 3 large, post-acute rehabilitation systems located in the Southeastern and Midwestern United States during the COVID-19 pandemic.

Effect of Risk-Stratified Care on Disability Among Adults With Low Back Pain Treated in the Military Health System: A Randomized Clinical Trial.

Importance: Tailored treatments for low back pain (LBP) based on stratifying risk for poor prognosis have emerged as a promising approach to improve quality of care, but they have not been validated in trials at the level of individual randomization in US health systems.

Objective: To assess the clinical effectiveness of risk-stratified vs usual care on disability at 1 year among patients with LBP.

Design, Setting, And Participants: This parallel-group randomized clinical trial enrolled adults (ages 18-50 years) seeking care for LBP with any duration in primary care clinics within the Military Health System from April 2017 to February 2020.

The Psychologically Informed Practice Consultation Roadmap: A Clinical Implementation Strategy.

Psychologically informed practice (PiP) includes a special focus on psychosocial obstacles to recovery, but research trials have revealed significant difficulties in implementing PiP outside of research environments. Qualitative studies have identified problems of both competence and confidence in tackling the psychosocial aspects of care, with a tendency to prefer dealing with the more mechanical aspects of care. In PiP, the distinction between assessment and management is not clear-cut.

Psychologically Informed Practice: The Importance of Communication in Clinical Implementation.

There has been increasing interest in the secondary prevention of chronic pain and pain-associated disability over the past 3 decades. In 2011, psychologically informed practice (PiP) was suggested as a framework for managing persistent and recurrent pain, and, since then, it has underpinned the development of stratified care linking risk identification (screening). Although PiP research trials have demonstrated clinical and economic advantage over usual care, pragmatic studies have been less successful, and qualitative studies have identified implementation difficulties in both system delivery and individual clinical management.

PROTOCOL: Fear avoidance model psychological factors as predictors for persistent post-concussion clinical outcomes: An integrative review.

Background: Persisting symptoms after concussion (PSaC) include physical, cognitive, and psychological symptoms which contribute to rehabilitation challenges. Previous research has not thoroughly investigated the association between PSaC and pain-related psychological factors. Therefore, there is an opportunity to use current pain models, such as the Fear Avoidance Model (FAM), as a framework to explore these relationships.

Librarian and Researcher Assessments of Search Result Relevance: How Well Do They Align?

Conducting comprehensive but efficient literature searches for complex evidence syntheses involves selecting databases that will retrieve the greatest number of relevant results on the question. Lack of a comprehensive single database on allied health educational topics challenges those seeking such literature. In this study, six participants contributed research questions on instructional methods and materials for allied health patients, caregivers, and future health professionals.

Characteristics and Outcomes of Patients Receiving Physical Therapy for Low Back Pain with a Nociplastic Pain Presentation: A Secondary Analysis.

Introduction: Individuals with low back pain (LBP) may be classified based on mechanistic descriptors, such as a nociplastic pain presentation (NPP). The purpose of this secondary analysis was to examine the frequency and characteristics of patients with a NPP referred to physical therapy with LBP. Additionally, we characterized patients with LBP meeting the criteria for NPP by demographic, clinical, psychological, and pain sensitivity variables.

Pain phenotyping and investigation of outcomes in physical therapy: An exploratory study in patients with low back pain.

Phenotypes have been proposed as a method of characterizing subgroups based on biopsychosocial factors to identify responders to analgesic treatments. This study aimed to, first, confirm phenotypes in patients with low back pain receiving physical therapy based on an a priori set of factors used to derive subgroups in other pain populations. Second, an exploratory analysis examined if phenotypes differentiated pain and disability outcomes at four weeks of physical therapy.

Racial and Ethnic Disparities in the Incidence of High-Impact Chronic Pain Among Primary Care Patients with Acute Low Back Pain: A Cohort Study.

Objective: We assessed whether race or ethnicity was associated with the incidence of high-impact chronic low back pain (cLBP) among adults consulting a primary care provider for acute low back pain (aLBP).

Methods: In this secondary analysis of a prospective cohort study, patients with aLBP were identified through screening at seventy-seven primary care practices from four geographic regions. Incidence of high-impact cLBP was defined as the subset of patients with cLBP and at least moderate disability on Oswestry Disability Index [ODI >30]) at 6 months.

Expectations affect pain sensitivity changes during massage.

Background: Pain-inducing massage produces comparable changes in pain sensitivity as a cold pressor task, suggesting shared neurophysiological mechanisms of conditioned pain modulation. Manual therapy and conditioned pain modulation are influenced by positive and negative expectations. Therefore, the purpose of this study was to examine the effects of positive and negative expectations on pain-free and pain-inducing massage.

Treatment effect modifiers for individuals with acute low back pain: secondary analysis of the TARGET trial.

Treatment effect modifiers identify patient characteristics associated with treatment responses. The purpose of this secondary analysis was to identify potential treatment effect modifiers for disability from the TARGET trial that compared usual care (control) with usual care + psychologically informed physical therapy (PIPT). The sample consisted of a STarT Back tool identified high-risk patients with acute low back pain that completed Oswestry Disability Index (ODI) data at index visit and 6 months later (n = 1250).

Postconcussion Symptom Catastrophizing Scale: Preliminary Reliability and Validity Analysis of Cross-sectional Data.

Objective: The aim of the study was to describe cross-sectional relationships between postconcussion symptom catastrophizing and patient-level factors in a postconcussion cohort.

Design: This cross-sectional study was conducted in an outpatient rehabilitation hospital concussion clinic and consisted of adults undergoing a neuropsychological evaluation. Cronbach α assessed internal consistency for Post-Concussion Symptom Catastrophizing Scale total scores.

American Physical Therapy Association Clinical Practice Guideline Implementation for Neck and Low Back Pain in Outpatient Physical Therapy: A Nonrandomized, Cross-sectional Stepped-Wedge Pilot Study.

Objective: To determine whether a multifaceted implementation strategy for American Physical Therapy Association neck and low back pain clinical practice guidelines (CPGs) was associated with changes in clinician and patient outcomes.

Design: Cross-sectional stepped-wedge pilot study.

Methods: Physical therapy clinics (n = 9) were allocated to 1 of 4 clusters that varied by CPG implementation timing.

Procedural Drift: An Underappreciated Element of Clinical Treatment Fidelity.

Procedural fidelity involves delivering the correct guideline-supported treatment choice, in its designed manner, over the full care episode of the patient. Procedural drift is a subcomponent of procedural fidelity that involves performing the right treatment the right way initially, then drifting toward suboptimal treatment over time. Procedural drift occurs most often when providing intricate, patient-centered interventions that require attention to subtle nuances that potentially maximize their effectiveness.

Low Risk for Persistent Back Pain Disability Is Characterized by Lower Pain Sensitivity and Higher Physical Performance.

Objective: The STarT Back Tool (SBT) predicts risk for persistent low back pain (LBP)-related disability based on psychological distress levels. Other non-psychological factors associated with LBP, such as pain sensitivity and physical performance, may further characterize SBT-risk subgroups. The purpose of this study was to determine whether a low-risk SBT subgroup demonstrated lower pain sensitivity and/or higher physical performance compared with a medium-/high-risk SBT subgroup.

Interventions for the Management of Acute and Chronic Low Back Pain: Revision 2021.

Low back pain (LBP) remains a musculoskeletal condition with an adverse societal impact. Globally, LBP is highly prevalent and a leading cause of disability. This is an update to the 2012 Academy of Orthopaedic Physical Therapy (AOPT), formerly the Orthopaedic Section of the American Physical Therapy Association (APTA), clinical practice guideline (CPG) for LBP.