The theory underlying psychologically informed care is sound, and its practical application aligns well with a physical therapist’s mission to help improve patient outcomes and enhance quality of life, though the question that matters most is, does it work? Is there research to support the claim that psychologically informed care works? Welcome to PIPT.

What is Psychologically Informed Physical Therapy (PIPT)?

PIPT is the term that has been used to define a biopsychosocial approach to physical therapy rehabilitation, emphasizing cognitive-behavioral skills in helping patients manage their pain.

This article summarizes five studies that investigated the outcomes of psychologically informed physical therapy, with regard to a variety of musculoskeletal conditions.

5 Studies Supporting Psychologically Informed Physical Therapy (PIPT

1. PIPT and Knee Osteoarthritis

A 2016 multi-site randomized controlled trial in Arthritis Care and Research examined 222 adults with knee osteoarthritis and unspecified knee pain. (1) Participants were separated into the following three groups:

1) Exercise only group

2) Pain coping skills only group

3) Exercise and pain coping skills training group

All 3 groups received individual sessions with a trained physiotherapist over the course of the 12-week study. At 52 weeks following study conclusion, the PIPT group showed statistically significant improvement in self-efficacy, pain coping, anxiety, stress, and quality of life. (2)

2. PIPT and Chronic Knee Pain

In 2012, a pragmatic cluster randomized, controlled trial of 418 people with chronic knee pain, aged 50 years and older, was published in Arthritis Care and Research. The RCT  was conducted to assess the effectiveness of a PIPT program, compared to care offered by the primary health care provider. (3) The PIPT program included education, self-management skills, and exercise. Study results revealed a significant between-group difference that showed greater improvement in physical function for the group who received PIPT, compared to those who received usual primary care.

3. PIPT and Neck Pain

In 2016, Thompson and colleagues conducted a multi-center randomized controlled trial, comparing  an intervention program with psychologically informed physical therapy to an exercise-only program in 57 patients who had non-specific neck pain. (4) Intervention components for the PIPT group included the following:

• • Goal setting
  • CBT strategies
  • Problem-solving training
  • Prescribed exercises for neck pain

At the study follow up, the intervention group showed greater pain reduction and increased improvement in self-efficacy.

Here are 7 different types of cognitive-behavioral skills for modern pain practitioners.

4. PIPT and Degenerative Lumbar Spine Pain

In the Journal of Pain, a randomized controlled trial was conducted among 86 adults undergoing a laminectomy for a degenerative spinal condition. The study used a telephone-based PIPT, and the findings were promising. (5) Subjects were randomized to either a cognitive-behavioral intervention group or an education program.

PIPT intervention techniques included the following (6):

• • Pacing

• • Graded activity

• • Problem-solving training

• • Distraction techniques

• • Cognitive restructuring

• • Relaxation skills

In comparison, the education group provided participants with information concerning post-op recovery, as well as suggestions on how to prevent future injury. Study results were impressive, especially considering the PIPT that was provided comprised just five 30-minute telephone sessions after the initial one-hour consultation! The group that received psychologically informed physical therapy showed more improvement in back pain, leg pain, pain interference, disability, as well as general physical and mental health, compared to their education-only counterparts.

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5. PIPT and Non-Specific Low Back Pain

Five randomized, controlled trials of patients with lower back pain treated by physiotherapists using CB intervention were published between 2002 and 2010. (7) The PIPT components included:

• Goal setting

• Pain education

• Benefits of exercise

• Cognitive restructuring

The authors concluded that there is high-quality evidence showing that CBT interventions are more effective in reducing long-term pain and disability, compared to other active treatments. The authors specifically pointed out the benefits of PIPT techniques in offering longer-term pain management, versus care that focused exclusively on the physical element, such as massage therapy and acupuncture. (7)   

General interest in psychologically informed physical therapy has increased substantially in the last decade, and there is promising evidence for its effectiveness in treating musculoskeletal pain. With some education and effort, cognitive-behavioral principles can easily be adopted into any physiotherapy program, and given the research supporting its potential benefits, it seems an effort worth making.

Are you interested in incorporating PIPT into your physical therapy practice? Have you observed evidence that it works? We want to hear from you. Please leave a comment for us below or find us on Facebook!

REFERENCES:

1.    Bennell KL, Ahamed Y, Jull G, et al. Physical therapist-delivered pain coping skills training and exercise for knee osteoarthritis: randomized controlled trial. Arthritis Care Res (Hoboken) 2016;68(5):590-602.
2.    Archer KR, Coronado RA, Wegener ST. The role of psychologically informed physical therapy for musculoskeletal pain. J Pain 2016;17:76-89.
3.    Hurley MV, Walsh NE, Mitchell H, et al. Long-term outcomes and costs of an integrated rehabilitation program for chronic knee pain: a pragmatic, cluster randomized, controlled trial. Arthritis Care Res (Hoboken) 2012;64:238-47.
4.    Thompson DP, Oldham JA, Woby SR. Does adding cognitive-behavioral physiotherapy to exercise improve outcome in patients with chronic neck pain? A randomised controlled trial. Physiotherapy 2016;102:170-7.
5.    Archer KR, Devin CJ, Vanston SW, et al. Cognitive-behavioral -based physical therapy for patients with chronic pain undergoing lumbar spine surgery: a randomized controlled trial. J Pain 2016;17:76-89.
6.    Archer KR, Motzny N, Abraham CM, et al. Cognitive-behavioral based physical therapy to improve surgical spine outcomes: a case series. Phys Ther 2013;93:1130-9.
7.    Hall A, Richmond H, Copsey B, et al. Physiotherapist-delivered cognitive-behavioral interventions are effective for low back pain, but can they be replicated in clinical practice? A systematic review. Disabil Rehabil 2016;21:1-9.