- ICH GCP
- US Clinical Trials Registry
- Klinisk forsøg NCT03168165
PNE Effectiveness Cluster Trial (PNE)
The Effectiveness of Training Physical Therapists in Pain Neuroscience Education on Patient Reported Outcomes for Patients With Chronic Spinal Pain
Studieoversigt
Status
Betingelser
Intervention / Behandling
Detaljeret beskrivelse
Chronic spinal pain is a very common and costly condition. An estimated 26.4% of Americans have experienced an episode low back pain (LBP) and 13.8% have experienced neck pain in the past 3 months. Lifetime prevalence of spinal pain ranges from 54% to 80% and the estimated healthcare costs for those with spinal pain are 57% higher than those without. While many with acute LBP have a favorable prognosis, those who develop chronic pain continue will experience persistent poor health and place a large burden on the healthcare system.
With growing healthcare costs and mounting disability, there is increased demand for physical therapists to promote more effective self-management strategies for patients with chronic spinal pain. Education is a critical component of self-management. Pain neuroscience education (PNE) is an education method used by physical therapists to help patients understand the biology, physiology and psychological factors influencing their pain experience and to reconcile faulty cognitions and beliefs associated with persistent pain and disability8. PNE has been shown to have positive effects on patient-reported outcomes for a variety of spinal pain conditions. This study will examine the impact of widespread implementation of PNE into routine physical therapy care.
The proposed mechanism of PNE is proposed to relate changes in patients' conceptualization of the pain experience, specifically concepts associated with fear, knowledge, and beliefs of pain. Additional research has identified autonomous motivation and self-efficacy as relevant to patients' behavioral responses to pain. Autonomous motivation is proposed to be an essential factor for behavior change, adhering to a treatment program and persistent positive health behavior changes. Autonomous motivation has not been examined as an influencing factor in the PNE model. Self-efficacy relates to the degree an individual feels they have control over their situation; and high self-efficacy has been associated with more active coping efforts. This study will examine self-efficacy and autonomous motivation as potential mediators of the ability of a PNE intervention improve functional outcomes in a pragmatic clinical environment.
This project's overall goal is to determine the effectiveness of providing physical therapists with PNE training on patient-centered outcomes (physical function and pain interference) for patients with chronic neck or back pain receiving physical therapy. Secondarily, the investigators will explore mechanisms of effects of PNE by examining the role of autonomous motivation and self-efficacy. To accomplish these goals, the investigators will conduct a cluster-randomized clinical trial, randomly assigning groups of clinics to receive PNE training or usual care with no additional training for physical therapists working in the clinic. This design allows for maximum external validity and generalizability across outpatient physical therapy clinics.
Primary Aims I. Compare effectiveness of PNE training vs. no additional training for physical therapists on patient-centered outcomes (physical function and pain interference) for patients with chronic spinal pain. The investigators hypothesize patients receiving treatment from physical therapists receiving PNE education will show greater improvement in patient-centered outcomes.
Secondary Aims I. Compare the effects of PNE training vs. no additional training for physical therapists on the patient-physical therapist alliance. The investigators hypothesize patients receiving treatment from physical therapists receiving PNE education will show greater alliance with their physical therapist.
II. Explore the mediating effects of autonomous motivation and self-efficacy on patient-centered outcomes. The investigators hypothesize autonomous motivation and/or self-efficacy will mediate the effects of education on patient-centered outcomes.
Undersøgelsestype
Tilmelding (Faktiske)
Fase
- Ikke anvendelig
Kontakter og lokationer
Studiesteder
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Alabama
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Birmingham, Alabama, Forenede Stater, 35242-8601
- BenchMark
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Birmingham, Alabama, Forenede Stater, 35243-2366
- BenchMark
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Helena, Alabama, Forenede Stater, 35080-3773
- BenchMark
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Hoover, Alabama, Forenede Stater, 35244-1254
- BenchMark
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Moody, Alabama, Forenede Stater, 35004-3101
- BenchMark
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Phenix City, Alabama, Forenede Stater, 36867-7484
- BenchMark
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Georgia
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Acworth, Georgia, Forenede Stater, 30101-8352
- Benchmark Physical Therapy
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Alpharetta, Georgia, Forenede Stater, 30005-4202
- BenchMark
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Atlanta, Georgia, Forenede Stater, 30306-4530
- BenchMark
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Atlanta, Georgia, Forenede Stater, 30308-1245
- BenchMark
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Atlanta, Georgia, Forenede Stater, 30316-6833
- BenchMark
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Atlanta, Georgia, Forenede Stater, 30318-3117
- BenchMark
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Atlanta, Georgia, Forenede Stater, 30319
- BenchMark
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Atlanta, Georgia, Forenede Stater, 30342-1461
- BenchMark
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Austell, Georgia, Forenede Stater, 30106-8531
- BenchMark
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Canton, Georgia, Forenede Stater, 30114-5603
- BenchMark
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Canton, Georgia, Forenede Stater, 30115-9376
- BenchMark
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Carrollton, Georgia, Forenede Stater, 30117-4456
- BenchMark
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Cartersville, Georgia, Forenede Stater, 30121-3305
- BenchMark
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Columbus, Georgia, Forenede Stater, 31909-5649
- BenchMark
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Dallas, Georgia, Forenede Stater, 30157-4702
- BenchMark
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Decatur, Georgia, Forenede Stater, 30033-5305
- BenchMark
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Dunwoody, Georgia, Forenede Stater, 30338-4163
- BenchMark
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Hiram, Georgia, Forenede Stater, 30141-2692
- BenchMark
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Jasper, Georgia, Forenede Stater, 30143-8704
- BenchMark
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Kennesaw, Georgia, Forenede Stater, 30144-3210
- BenchMark
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Lawrenceville, Georgia, Forenede Stater, 30046-8767
- Rehab South
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Marietta, Georgia, Forenede Stater, 30060-9412
- BenchMark
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Marietta, Georgia, Forenede Stater, 30062-4197
- BenchMark
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Marietta, Georgia, Forenede Stater, 30064-5037
- BenchMark
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Marietta, Georgia, Forenede Stater, 30067-8642
- BenchMark
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Marietta, Georgia, Forenede Stater, 30068-5418
- BenchMark
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Newnan, Georgia, Forenede Stater, 30265-6506
- Rehab South
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Peachtree City, Georgia, Forenede Stater, 30269-1571
- Rehab South
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Peachtree City, Georgia, Forenede Stater, 30269
- BenchMark
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Roswell, Georgia, Forenede Stater, 30075-7524
- BenchMark
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Roswell, Georgia, Forenede Stater, 30076-0929
- BenchMark
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Roswell, Georgia, Forenede Stater, 30076-3866
- BenchMark
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Smyrna, Georgia, Forenede Stater, 30080-9213
- BenchMark
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Suwanee, Georgia, Forenede Stater, 30024-9104
- BenchMark
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Tucker, Georgia, Forenede Stater, 30084-4916
- BenchMark
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Deltagelseskriterier
Berettigelseskriterier
Aldre berettiget til at studere
Tager imod sunde frivillige
Køn, der er berettiget til at studere
Beskrivelse
Inclusion Criteria:
- Age 18-75 at time of first physical therapy session
- Primary reason for physical therapy is low back and/or neck pain
- Meets the NIH definition of chronic pain (i.e., neck or back pain on at least half the days in the past 6 months.)
Exclusion Criteria:
- No spinal surgery within the previous 12 months
- No evidence of "red flag" conditions (e.g., cauda equine syndrome, cancer, fracture, infection or systemic disease) that requires immediate referral from physical therapy to medical care
- Not currently known to be pregnant
Studieplan
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Primært formål: Behandling
- Tildeling: Randomiseret
- Interventionel model: Parallel tildeling
- Maskning: Ingen (Åben etiket)
Våben og indgreb
Deltagergruppe / Arm |
Intervention / Behandling |
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Ingen indgriben: Usual Care
Usual care, no intervention
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Eksperimentel: Pain Neuroscience Education Training
The region of clinics randomized to this arm will receive PNE education, which consists of 6 weeks online training followed by an on-site training day.
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PNE training will consist of 6 weeks online training followed by one day training session.
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Hvad måler undersøgelsen?
Primære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
---|---|---|
Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function
Tidsramme: 2 week and 12 week
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Change score of Physical Function scores from baseline
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2 week and 12 week
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Sekundære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
---|---|---|
Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference
Tidsramme: 2 week and 12 week
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Change score of Pain Interference scores from baseline
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2 week and 12 week
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pain self-efficacy
Tidsramme: 2 week and 12 week
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Measured by Pain Self-Efficacy Questionnaire
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2 week and 12 week
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Autonomous motivation
Tidsramme: 2 week and 12 week
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Measured by Treatment Self-regulation Questionnaire
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2 week and 12 week
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Therapeutic Alliance
Tidsramme: 2 week and 12 week
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As measured by Working Alliance Theory of Change Inventory
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2 week and 12 week
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Samarbejdspartnere og efterforskere
Sponsor
Publikationer og nyttige links
Generelle publikationer
- Lane E, Magel JS, Thackeray A, Greene T, Fino NF, Puentedura EJ, Louw A, Maddox D, Fritz JM. Effectiveness of training physical therapists in pain neuroscience education for patients with chronic spine pain: a cluster-randomized trial. Pain. 2022 May 1;163(5):852-860. doi: 10.1097/j.pain.0000000000002436.
- Lane E, Fritz JM, Greene T, Maddox D. The effectiveness of training physical therapists in pain neuroscience education on patient reported outcomes for patients with chronic spinal pain: a study protocol for a cluster randomized controlled trial. BMC Musculoskelet Disord. 2018 Oct 25;19(1):386. doi: 10.1186/s12891-018-2269-2.
Datoer for undersøgelser
Studer store datoer
Studiestart (Faktiske)
Primær færdiggørelse (Faktiske)
Studieafslutning (Faktiske)
Datoer for studieregistrering
Først indsendt
Først indsendt, der opfyldte QC-kriterier
Først opslået (Faktiske)
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Faktiske)
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidst verificeret
Mere information
Begreber relateret til denne undersøgelse
Yderligere relevante MeSH-vilkår
Andre undersøgelses-id-numre
- 00097154
Plan for individuelle deltagerdata (IPD)
Planlægger du at dele individuelle deltagerdata (IPD)?
Lægemiddel- og udstyrsoplysninger, undersøgelsesdokumenter
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Vrije Universiteit BrusselUniversiteit AntwerpenAfsluttetSmerte | Barn | Undersøgelser og spørgeskemaer | Viden | ValideringBelgien
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