Feasibility and acceptability of telephone‐delivered cognitive‐behavioral‐based physical therapy for patients with traumatic lower extremity injury

Claudia A Davidson,William T Obremskey,Rogelio A Coronado,Abigail L Henry,Kristin R Archer,Stephen T Wegener,Elizabeth G Blade,Susan W Vanston

doi:10.1111/jabr.12163

Abstract

AbstractPurposeTo determine feasibility and acceptability of a telephone‐based Cognitive‐Behavioral‐Based Physical Therapy program for patients following traumatic lower extremity injury (CBPT‐Trauma).MethodsPatients were screened for high psychosocial risk factors and then completed the 6‐week CBPT‐Trauma program. Physical function, pain, and psychosocial outcomes were assessed at baseline and 6‐months follow‐up. Descriptive statistics assessed change in outcomes.ResultsRecruitment rate was 59%. Twenty‐seven patients (73%) had a high psychosocial risk profile. Twelve patients completed the program and the follow‐up assessment at 6 months and found the program to be very or extremely helpful to their overall recovery. All demonstrated a clinically meaningful increase in physical function. Six patients demonstrated a clinically relevant decrease in pain intensity, pain catastrophizing, and fear of movement. Seven patients reported a clinically meaningful increase in pain self‐efficacy.DiscussionFindings suggest that recruitment is feasible for CBPT‐Trauma program. However, engagement in the CBPT‐Trauma study was low. For those that completed the program, patients were satisfied with the CBPT‐Trauma program and experienced meaningful improvement in psychosocial factors and patient‐reported outcomes. This open pilot study highlights the importance of targeted treatment for patients at high‐risk for poor outcomes and the potential for increased access to services through telephone‐delivery.

Highlights

Acute orthopedic trauma is a major global health burden (Clay, Watson, Newstead, & McClure, 2012)
The feasibility results demonstrated that recruitment is feasible for a targeted CBPT‐Trauma program, with 59% of eligible and approached patients providing consent during the early recovery period and 73% of consented patients screening positive for high pain catastrophizing, high fear of movement, and/or low pain self‐efficacy
Future work with the CBPT‐trauma program should consider additional intermediary measures that assess a range of both risk and protective factors, such as resiliency, coping and anxiety, to better understand the underlying mechanisms of Cognitive behavioral therapy (CBT)‐based strategies in this orthopedic patient population

Summary

Introduction

Acute orthopedic trauma is a major global health burden (Clay, Watson, Newstead, & McClure, 2012). Two‐thirds of the annual estimated 2.5 million hospitalized trauma survivors have one or more extremity injuries, with the majority being moderately severe to severe (Dillingham, Pezzin, & Mackenzie, 1998; Pezzin, Dillingham, & MacKenzie, 2000; Rice, MacKenzie, & Jones, 1989). Traumatic lower‐extremity injuries often result in chronic pain, long‐term disability, and low rates of return to work (Ponsford, Hill, Karamitsios, & Bahar‐Fuchs, 2008). One of the strongest predictors of chronic pain following traumatic injury, as well as long‐term physical and psychological disability, is a high level of pain early in the recovery process (Archer, Devin, et al, 2016; Castillo, MacKenzie, Wegener, Bosse, & Group, 2006; Castillo, Wegener, Newell, et al, 2013; Clay et al, 2010; Rivara et al, 2008; Wegener et al, 2011; Williamson et al, 2009). Unmanaged pain leads to repeat hospitalizations, low satisfaction with healthcare, and delayed functional recov‐ ery and return to work (MacKenzie et al, 2006; OToole, Castillo, Pollak, MacKenzie, & Bosse, 2008)

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Discussion

Conclusion