Study Spotlight: Exploring the Issue of Psychosocial Factors in LBP

Psychosocial factors—including fear of movement and anxiety about the future—are an expected and normal part of LBP experiences.

Low back pain (LBP) interventions are often categorized as “physical” or
“psychological,” creating a potential barrier to recovery in some patients who may be inhibited by these psychosocial factors. An article published in the British Journal of Sports Medicine challenges this separation, stating that understanding and addressing psychosocial factors in clinical practice can help better optimize patient management.

In the research, O’Keeffe et al investigated how psychosocial factors do not always indicate mental health disorders and are not distinct from biological factors. Reductions in pain and disability after treatment are, to some degree, facilitated by changes in non-physical factors, like self-efficacy. For example, exposure to a specific movement that the patient fears paired with an empowering narrative from the provider can reduce the associated fear or anxiety.

The study also argued that psychosocial factors do not only appear in persistent pain presentations. In fact, the authors, who included Steven Z. George, PT, PhD, FAPTA, a member of MedRisk’s International Scientific Advisory Board (ISAB), said that psychosocial factors are an expected and normal part of LBP experiences, acute or chronic.

Psychosocial factors may be just as important to consider as “other factors” when a patient “fails” during “normal” treatment. Exploring and addressing these factors at the front end will ultimately drive more successful patient outcomes. This research supports MedRisk’s PTConsult, a service that makes adjusters aware of any psychosocial factors and provides patient education on the importance of physical therapy, treatment expectations and any perceived barriers to recovery (including anxiety).

To read the full article, click here.

O’Keeffe M, George SZ, O’Sullivan PB, et al Psychosocial factors in low back pain: letting go of our misconceptions can help management. British Journal of Sports Medicine 2019;53:793-794.

Study Spotlight: Telehealth Earns Positive Reviews During Pandemic

Recent study finds high levels of satisfaction with telehealth among outpatient therapy patients.

In a recent article published in the American Journal of Physical Medicine & Rehabilitation, Tenforde et al reviewed findings from a survey of 211 study participants who received a telehealth visit for lower limb injuries, pediatric neurology, or primary impairments in sports during the COVID-19 pandemic.

Intended to gather “measures of experience with a therapist” including physical therapists (PTs), occupational therapists (OTs), and speech language pathologists (SLPs), the 16-item survey covered seven focus areas: addressing concerns and questions, therapist communication, treatment plan development, treatment plan execution, convenience, overall satisfaction and perceived value of a future telehealth visit.

More than half of the visits examined (53%) were with a PT, and the overall findings showed that over 90% of participants selected “excellent” or “good” when rating having their concerns addressed, communication with their therapist, treatment plan development and execution, convenience and overall satisfaction. About 87 of respondents replied with “excellent” or “good” when asked about the perceived value of having a future telehealth visit.

As a provider of telerehab services since 2017, MedRisk supports the authors’ commentary that high patient satisfaction scores across age, gender and condition point to the value telerehabilitation can provide, such as reduced travel time and convenience, beyond the public health emergency.

To read the complete article, click here.

Tenforde, Adam S. MD; Borgstrom, Haylee MD, MS; Polich, Ginger MD; Steere, Hannah MD; Davis, Irene S. PhD, PT; Cotton, Kester PT; O’Donnell, Mary MS, OTR/L; Silver, Julie K. MD Outpatient Physical, Occupational, and Speech Therapy Synchronous Telemedicine, American Journal of Physical Medicine & Rehabilitation: November 2020 – Volume 99 – Issue 11 – p 977-981 doi: 10.1097/PHM.0000000000001571

Study Spotlight: The Lasting Legacy of Delayed Injured Worker Treatment During the COVID-19 Pandemic

Non-urgent medical services were suspended across the country in spring 2020 to reserve resources for COVID-19 patients. How is this expected to impact injured worker treatment and associated costs in the long term?

In an unprecedented move for the U.S. health care system, many medical services were halted in spring 2020 to reserve resources for a potential surge of COVID-19 patients. There had been little published on the long-term effects of this on injured workers until the Workers’ Compensation Insurance Rating Bureau of California’s October 2020 report “Cost Impacts of Medical Care Delays in the California Workers’ Compensation System.” In it, the organization analyzed how the suspension of California’s non-urgent medical care in March and April 2020 impacted the state’s workers’ compensation system and its expected influence on claims in the long term.

The study used historical indemnity claim information to examine the implications of first medical service delays on medical and indemnity costs, which were found even four years after injury. The report showed that injured workers with soft tissue injuries whose first medical service was delayed a month had higher indemnity and medical costs that persisted for years. These claims were also more likely to stay open longer, have a longer duration of temporary disability, and involve permanent disability. Similar results were found for other common workers’ compensation diagnoses like low back pain, sprain, and fracture.

Importantly, soft tissue claims with postponed first physical therapy treatment also had significantly higher medical and indemnity costs for years following injury compared to similar claims with no PT delays. These findings reinforce MedRisk’s commitment to helping injured workers receive prompt physical therapy treatment, with an average 4-hour turnaround time from referral to scheduling and just 2.6 days to initial evaluation.

Click here to read the WCIRB’s full report.

Study Spotlight: The Power of Patient Education in Treating Chronic Low Back Pain

Should symptoms-based physical treatment remain the go-to approach for treating chronic LBP?

Over the last decade, cognitive interventions have become the subject of dialogue and research regarding the treatment of chronic low back pain (LBP). Studies have shown that cognitive interventions, such as those that address perceptions of pain, demonstrate similar rates of effectiveness in self-reported disability and sick leave when compared to traditional treatments. These findings were tested further in the first study to compare a cognitive education method based on a non-injury model with that of more traditional symptom-based physical training for chronic LBP.

In BMC Musculoskeletal Disorders, Sorensen et al shared the framework for this study, which compared (1) an educational approach designed to improve confidence in the robustness of the spine and (2) symptom-based physical training treatment. Primary outcomes were back pain and activity limitation, and secondary outcomes were attitudes regarding LBP, physical activity levels, work ability, quality of life, sick leave, as well as various other healthcare treatments.

The study found that, despite having fewer treatment sessions, cognitive, education intervention for chronic LBP resulted in at least equivalent outcomes as a symptom-based physical training method. These findings support MedRisk’s commitment to providing consultations to injured workers in advance of treatment to educate patients on the importance of physical therapy, describe what to expect, and address any perceived barriers to recovery.

Sorensen, P.H., Bendix, T., Manniche, C. et al. An educational approach based on a non-injury model compared with individual symptom-based physical training in chronic LBP. A pragmatic, randomised trial with a one-year follow-up. BMC Musculoskelet Disord 11, 212 (2010).