Efficacy of a Psychologically-Informed Physiotherapy Intervention in Patients with Chronic Low Back Pain at High Risk of Poor Prognosis: A Pilot and Feasibility Randomised Controlled Trial

Purpose: To determine the feasibility of a randomized controlled trial (RCT) testing the efficacy of psychologically-informed physiotherapy (PIPT), which includes usual physiotherapy (UP) interventions, compared with UP, and to explore the preliminary effectiveness of the interventions.Method: People with chronic low back pain at high risk of poor prognosis (using the Start Back screening tool) were recruited and allocated to PIPT or UP. Effectiveness of recruitment strategies, adherence to intervention, risk of contamination, and specific challenges were assessed. Functional capacity, pain, quality of life, kinesiophobia, catastrophization, central sensitization, and self-efficacy were measured at baseline, 6-, 12- and 24-week follow-ups.Results: Forty participants were recruited mainly by diffusing through Laval University's email list, and 10 physiotherapists treated the participants recruited. The retention rate of participants at 24 weeks was 72.5%. Adherence to treatment by participants and physiotherapists was very good. The risk of contamination was low, and the specific challenges identified were modifiable. Significant improvement over time in all clinical variables of interest, except self-efficacy, was observed with no difference between groups.Conclusions: As most success criteria were met, conducting an RCT evaluating PIPT and PU is feasible with modifications. PIPT and UP appear to be similarly effective. Objectif : determiner la faisabilite d'une etude randomisee et controlee (eRC) evaluant l'efficacite de la physiotherapie fondee sur la psychologie (PTFP), qui inclut les interventions de physiotherapie conventionelle (PC), par rapport a la PC, et explorer l'efficacite preliminaire des interventions.Methodologie : les chercheurs ont recrute des personnes qui souffrent de douleurs lombaires chroniques, ayant une probabilite elevee de mauvais pronostic (au moyen de l'outil de depistage Start Back) et les ont reparties entre la PTFP et la PC. Ils ont evalue l'efficacite des strategies de recrutement, l'adhesion a l'intervention, le risque de contamination et les difficultes particulieres. Ils ont egalement mesure la capacite fonctionnelle, la douleur, la qualite de vie, la kinesiophobie, la catastrophisation, la sensibilisation centrale et l'autoefficacite en debut d'etude ainsi que lors des suivis a six, 12 et 24 semaines.Resultats : les chercheurs ont recrute 40 participants, principalement en diffusant le projet par courriel a la communaute de l'Universite Laval, et dix physiotherapeutes les ont traites. Le taux de retention des participants etait de 72,5 % a 24 semaines. Les participants et les physiotherapeutes ont demontre une tres bonne adhesion au traitement. Le risque de contamination etait faible, et les difficultes particulieres constatees pouvaient etre modifiees. Les chercheurs ont observe une amelioration considerable au fil du temps pour toutes les variables cliniques d'interet, sauf l'autoefficacite, sans difference entre les groupes.Conclusions : puisque la plupart des criteres de succes etaient respectes, il est faisable de realiser une eRC pour evaluer la PTFP et la PU, sous reserve de modifications. La PTFP et la PC semblent avoir une efficacite similaire.