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The Development of a Cognitive Reassurance Training Program

14 aprile 2020 aggiornato da: Jake Magel, University of Utah

The Development of a Cognitive Reassurance Training Program and Its Impact on Physical Therapist and Patient Outcomes

The focus of this proposal is to evaluate the feasibility of a cognitive reassurance training program by examining changes in physical therapist low back pain beliefs and skills with training and evaluating the quality with which physical therapists apply cognitive reassurance to patients. The secondary focus is to examine the association between physical therapist application of cognitive reassurance and short-term changes in patients' low back pain beliefs and expectations.

Panoramica dello studio

Stato

Terminato

Condizioni

Intervento / Trattamento

Descrizione dettagliata

Identifying strategies to favorably alter unhelpful cognitions of patients with recent onset low back pain is a research priority and could help curb the transition from acute to chronic low back pain; lessening the need for prolonged and costly management. Current evidence suggests that psychological factors, including maladaptive pain beliefs and avoidant behaviors and expectations for recovery, are associated with poor outcomes in patients with low back pain. Recently, considerable attention has been given to training non-psychologists to provide psychologically based interventions for patients with low back pian. A recent review of interventions that included psychological approaches noted that all of the trials that failed to show benefit included delivery of the intervention by non-psychologists. Authors suggest that increasing the effort in selecting, training, supervising and assessing the competence of the practitioners delivering the treatment could improve results.

Low back pain comprises approximately 50% of the caseload of outpatient physical therapists physical therapists making physical therapists ideally positioned to manage the unhelpful cognitions of patients with low back pain. However, physical therapists often feel unprepared when managing the cognitive factors associated with low back pain. The purpose of this project is to develop and assess the effectiveness of a training program for physical therapists that focuses on cognitive reassurance; a novel cognitive intervention for patients with low back pain.

Cognitive reassurance is a communication approach in which maladaptive beliefs and expectations are identified. Tailored explanations for the patient's conditions are then provided, possible prognosis and treatment are discussed, and clarifications are offered. With adequate training, physical therapists could utilize cognitive reassurance to promote patients' understanding of his/her condition and modify maladaptive low back pain-related beliefs and expectations.

The proposed pilot study will use a pre-post design to examine the impact of cognitive reassurance training on the low back pain beliefs and skills in physical therapists and physical therapist assistants. Following the training the investigators will recruit patients who have scheduled an evaluation for low back pain with the physical therapists who attended the training. Patient data will be collected at baseline before the evaluation and follow up data at 2, 4 and 8 weeks.

The specific aims are: 1) Evaluate the feasibility of a cognitive reassurance training program for physical therapists that focuses on modifying physical therapists' beliefs and improving physical therapists' skill in the application of cognitive reassurance for patients with acute/subacute low back pain. 2) Evaluate the application of cognitive reassurance by physical therapists to patients with acute/sub-acute low back pain. 3) Examine the association between physical therapist application of cognitive reassurance and short-term changes in the patient's low back pain beliefs and expectations (low back pain beliefs, self-efficacy, pain catastrophizing, fear-avoidance).

Tipo di studio

Interventistico

Iscrizione (Effettivo)

128

Fase

  • Non applicabile

Contatti e Sedi

Questa sezione fornisce i recapiti di coloro che conducono lo studio e informazioni su dove viene condotto lo studio.

Luoghi di studio

  • Stati Uniti
    • Utah
      • Salt Lake City, Utah, Stati Uniti, 84132
        • University of Utah Health Care Out Patient Physical Therapy Clinics

Criteri di partecipazione

I ricercatori cercano persone che corrispondano a una certa descrizione, chiamata criteri di ammissibilità. Alcuni esempi di questi criteri sono le condizioni generali di salute di una persona o trattamenti precedenti.

Criteri di ammissibilità

Età idonea allo studio

18 anni e precedenti (Adulto, Adulto più anziano)

Accetta volontari sani

No

Sessi ammissibili allo studio

Tutto

Descrizione

Therapist inclusion criteria:

  • University of Utah Health Care physical therapists and physical therapist assistants
  • Employed at least 20 hours a week
  • Licensed in the state of Utah

Therapist exclusion criteria:

  • None

Patient inclusion criteria

  • Primary reason for scheduling an evaluation with a physical therapist is low back pain (defined as symptoms of pain and/or numbness between the 12th rib and buttocks with or without referral in to one or both legs
  • Current episode of low back pain ≤ 12 weeks duration
  • Age 18-64
  • Ability to read and speak English

Patient exclusion criteria

  • Report being referred to physical therapy for specific low back pathology (e.g. fracture)
  • Any lumbar surgery in the past 6 months
  • Current pregnancy

Piano di studio

Questa sezione fornisce i dettagli del piano di studio, compreso il modo in cui lo studio è progettato e ciò che lo studio sta misurando.

Come è strutturato lo studio?

Dettagli di progettazione

  • Scopo principale: Ricerca sui servizi sanitari
  • Assegnazione: N / A
  • Modello interventistico: Assegnazione di gruppo singolo
  • Mascheramento: Nessuno (etichetta aperta)

Armi e interventi

Gruppo di partecipanti / Arm
Intervento / Trattamento
Sperimentale: Provider training
Altro: Cognitive reassurance training
The 2-day training program includes 3 sessions that will consist of interactive didactic lectures, solving case studies and role-playing activities. The first session uses lecture and cases to present models of pain and disability, evidence based predictors of disability and delayed recovery and evidence based interventions for patients with low back pain. The second session uses role playing and case studies help the providers to 1) develop skills in identifying maladaptive beliefs about pain in patients with low back pain and 2) develop the skills to address diagnostic uncertainty and negative pain beliefs and 3) develop skills to educate patients with low back pain. The third session will use role playing and case studies to refine the provider' skills in providing cognitive reassurance to patients with low back pain.

Cosa sta misurando lo studio?

Misure di risultato primarie

Misura del risultato
Misura Descrizione
Lasso di tempo
Change in back beliefs questionnaire for health care providers
Lasso di tempo: Baseline, 5 days
Measures providers' beliefs about back pain pre and post training
Baseline, 5 days
Low back pain vignettes
Lasso di tempo: End of 2nd day of therapist training
Measures provider decision making related to cognitive reassurance
End of 2nd day of therapist training
Skills assessment
Lasso di tempo: End of 2nd day of therapist training
Assess skills in the provision of cognitive reassurance during role-playing activity
End of 2nd day of therapist training

Misure di risultato secondarie

Misura del risultato
Misura Descrizione
Lasso di tempo
Change in the Pain Catastrophizing Scale
Lasso di tempo: Baseline, 4 weeks and 8 weeks
Measure of patient's pain catastrophizing
Baseline, 4 weeks and 8 weeks
Change in fear the Avoidance Beliefs Questionnaire
Lasso di tempo: Baseline, 4 weeks and 8 weeks
Measure of patient's fear-avoidance beliefs.
Baseline, 4 weeks and 8 weeks
Change in the Pain Self-efficacy Questionnaire
Lasso di tempo: Baseline, 4 weeks and 8 weeks
Measure of patient's pain self-efficacy
Baseline, 4 weeks and 8 weeks
Change in the Back Beliefs Questionnaire
Lasso di tempo: Baseline, 4 weeks and 8 weeks
Measure of patient's back beliefs
Baseline, 4 weeks and 8 weeks
Patient check list
Lasso di tempo: 2 weeks following initial evaluation for low back pain by a physical therapist
Measure whether key messages of cognitive reassurance were perceived by the patient.
2 weeks following initial evaluation for low back pain by a physical therapist
Open-ended question
Lasso di tempo: 2 weeks following the initial evaluation for low back pain by a physical therapist
Asks the patient to list the most important things they learned learned in physical therapy
2 weeks following the initial evaluation for low back pain by a physical therapist
Provider check list
Lasso di tempo: 2 weeks status post initial evaluation of patient with low back pain
Measures whether key cognitive reassurance messages were provided to the patient by the provider
2 weeks status post initial evaluation of patient with low back pain

Collaboratori e investigatori

Qui è dove troverai le persone e le organizzazioni coinvolte in questo studio.

Sponsor

University of Utah

Investigatori

  • Investigatore principale: Jake S Magel, PT, PhD, University of Utah

Studiare le date dei record

Queste date tengono traccia dell'avanzamento della registrazione dello studio e dell'invio dei risultati di sintesi a ClinicalTrials.gov. I record degli studi e i risultati riportati vengono esaminati dalla National Library of Medicine (NLM) per assicurarsi che soddisfino specifici standard di controllo della qualità prima di essere pubblicati sul sito Web pubblico.

Studia le date principali

Inizio studio (Effettivo)

19 maggio 2017

Completamento primario (Effettivo)

25 agosto 2017

Completamento dello studio (Effettivo)

8 novembre 2018

Date di iscrizione allo studio

Primo inviato

8 agosto 2017

Primo inviato che soddisfa i criteri di controllo qualità

19 agosto 2017

Primo Inserito (Effettivo)

22 agosto 2017

Aggiornamenti dei record di studio

Ultimo aggiornamento pubblicato (Effettivo)

16 aprile 2020

Ultimo aggiornamento inviato che soddisfa i criteri QC

14 aprile 2020

Ultimo verificato

1 aprile 2020

Maggiori informazioni

Termini relativi a questo studio

Parole chiave

Termini MeSH pertinenti aggiuntivi

Altri numeri di identificazione dello studio

  • 00100188

Piano per i dati dei singoli partecipanti (IPD)

Hai intenzione di condividere i dati dei singoli partecipanti (IPD)?

No

Informazioni su farmaci e dispositivi, documenti di studio

Studia un prodotto farmaceutico regolamentato dalla FDA degli Stati Uniti

No

Studia un dispositivo regolamentato dalla FDA degli Stati Uniti

No

Queste informazioni sono state recuperate direttamente dal sito web clinicaltrials.gov senza alcuna modifica. In caso di richieste di modifica, rimozione o aggiornamento dei dettagli dello studio, contattare register@clinicaltrials.gov. Non appena verrà implementata una modifica su clinicaltrials.gov, questa verrà aggiornata automaticamente anche sul nostro sito web .

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