Abstract
BackgroundAcceptance and Commitment Therapy (ACT) is a form of cognitive behavioural therapy, which may be beneficial for people with chronic pain. The approach aims to enhance daily functioning through increased psychological flexibility. Whilst the therapeutic model behind ACT appears well suited to chronic pain, there is a need for further research to test its effectiveness in clinical practice, particularly with regards to combining ACT with physical exercise.Methods/designThis prospective, two-armed, parallel-group, single-centre randomised controlled trial (RCT) will assess the effectiveness of a combined Exercise and ACT programme, in comparison to supervised exercise for chronic pain. One hundred and sixty patients, aged 18 years and over, who have been diagnosed with a chronic pain condition by a physician will be recruited to the trial. Participants will be individually randomised to one of two 8-week, group interventions. The combined group will take part in weekly psychology sessions based on the ACT approach, in addition to supervised exercise classes led by a physiotherapist. The control group will attend weekly supervised exercise classes but will not take part in an ACT programme. The primary outcome will be pain interference at 12-week follow-up, measured using the Brief Pain Inventory-Interference Scale. Secondary outcomes will include self-reported pain severity, self-perception of change, patient satisfaction, quality of life, depression, anxiety and healthcare utilisation. Treatment process measures will include self-efficacy, pain catastrophising, fear avoidance, pain acceptance and committed action. Physical activity will be measured using Fitbit ZipTM activity trackers. Both groups will be followed up post intervention and again after 12 weeks. Estimates of treatment effects at follow-up will be based on an intention-to-treat framework, implemented using a linear mixed-effects model. Individual and focus group qualitative interviews will be undertaken with a purposeful sample of participants to explore patient experiences of both treatments.DiscussionTo our knowledge, this will be the first RCT to examine whether combining exercise with ACT produces greater benefit for patients with chronic pain, compared to a standalone supervised exercise programme.Trial registrationwww.ClinicalTrials.gov, ID: NCT03050528. Registered on 13 February 2017.
Highlights
Introduction to exercisePool orientationInduction to gym programmeDemonstration of gym exercisesGym exercise: Gentle warm up – walking and stretches Brief gym circuit Cool downGroup discussion on goal settingProvision of individual home exercise programme HEP created by physiotherapist based on patient’s individual goalsHydrotherapy Warm up Gentle aerobic and buoyancy assisted and resisted exercisesUnderstanding pain HydrotherapyGroup will be shown the YouTube video ‘understanding painWarm up in 5 minutes’ followed by a group question/answer session
To our knowledge, this will be the first randomised controlled trial (RCT) to examine whether combining exercise with ACT produces greater benefit for patients with chronic pain, compared to a standalone supervised exercise programme
One RCT included in these reviews compared ACT with cognitive behavioural therapy (CBT) and found no significant differences in improvement between the two treatments; greater levels of satisfaction were reported by the ACT participants [24]
Summary
Introduction to exercisePool orientationInduction to gym programmeDemonstration of gym exercisesGym exercise: Gentle warm up – walking and stretches Brief gym circuit Cool downGroup discussion on goal settingProvision of individual home exercise programme HEP created by physiotherapist based on patient’s individual goalsHydrotherapy Warm up Gentle aerobic and buoyancy assisted and resisted exercisesUnderstanding pain HydrotherapyGroup will be shown the YouTube video ‘understanding painWarm up in 5 minutes’ followed by a group question/answer session. Exercise interventions and psychological therapies, such as cognitive behavioural therapy (CBT), are examples of conservative treatments that are known to be effective for patients with chronic pain [5, 6, 9,10,11,12]. These interventions can be provided individually or they can be effectively combined in the form of a multidisciplinary biopsychosocial rehabilitation programme [13]
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