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Campello M.1, Weiser S.1, Lis A.1, Brennan T.1, Ziemke G.2, Hiebert R.2, Faulkner D.2, Iveson B.3, Southerst D.1
1New York University, Orthopedic Surgery, New York, United States, 2University of Delaware, Newark, United States, 3United States Navy, Portsmouth, United States
Background: In the US Navy, musculoskeletal injuries (MSIs) comprise about 40% of sick call visits during deployment and are the main cause of separation. Modifiable psychological factors are associated with disability in patients with MSI. Modifying psychological factors requires a shift from a biomedical to a biopsychosocial model of care. The authors successfully trained physical therapy staff (PTs) aboard a US Aircraft Carrier (carrier) to do this using "psychologically-based physical therapy" (PBPT). PBPT uses concepts from cognitive-behavioral therapy, including identification and modification of psychological risk factors, patient education and active, goal-oriented treatment. The effect of this treatment on patients' understanding of their MSI has not been reported.
Purpose: This abstract describes what subjects learned from PBPT, using qualitative data from a larger study testing the effectiveness of PBPT for MSIs in active duty service members (ADSM) aboard a carrier.
Methods: A quasi-experimental mixed methods study design was used to compare PT interventions aboard two carriers. PTs on both carriers received instructions on study procedures prior to deployment. Intervention carrier PTs also attended a three day PBPT course. Once deployed, training was reinforced with bimonthly phone calls between investigators and PTs. Therapy notes were analyzed to assess PBPT implementation. Four weeks post-enrollment, subjects completed follow-up questionnaires, including the open-ended question: "Please list the most important thing(s) you learned in physical therapy" designed to determine if messages that patients received from PTs differed between groups. Concepts consistent with PBPT messages (e.g. mind/body connection, pain is not damage) were established a priori and used to guide the qualitative analysis. Statements by the subjects consistent with PBPT concepts were considered an indication that the PBPT message was received. Three blinded raters independently assessed subjects responses. Only statements all three raters agreed on were considered to contain PBPT concepts. When raters disagreed responses were only considered to contain PBPT concepts if consensus was reached after discussion. PBPT concepts were considered absent from all other responses.
Results: Eighty-six intervention and 84 control subjects completed follow-up questionnaires. Of these, 26% (n=22) in the control carrier and 6% (n=5) in the intervention carrier did not answer the open-ended question. The number of responses reflecting PBPT concepts were 29 (34%) in the intervention carrier and 0 in the control carrier.
Conclusion(s): One third of the subjects exposed to PBPT reported learning PBPT concepts compared to zero control subjects. This is the first study to examine the transfer of PBPT knowledge from the PT to the patient. This is an important step in establishing the efficacy of this approach.
Implications: PBPT aimed at improving outcomes for patients with MSI shows promise. This study demonstrates that a sizable proportion of subjects who received PBPT learned the messages they were taught compared to usual care controls. This suggests that PBPT may be effective in modifying patient beliefs in a way that is associated with less work disability. We are currently analyzing the data to determine if such a change in patient beliefs is associated with better outcomes.
Funding acknowledgements: Study supported by the Office of the Assistant Secretary of Defense for Health Affairs through the CDMRP, Award No. W81XWH-14-2-0146
Topic: Disability & rehabilitation
Ethics approval: Research data derived from an approved Naval Medical Center, Portsmouth, VA IRB protocol.
All authors, affiliations and abstracts have been published as submitted.
