Article

Psychosocial prognostic factors are important in the development of
chronic pain, but treatment providers often lack knowledge and skills to assess
and address these risk factors. The aim of this study was to examine
the effects on outcomes (pain and disability) in patients of a course about
psychosocial prognostic factors for physical therapists.
This study was a
randomized, controlled trial.
The setting was primary care practice.
PARTICIPANTS: Forty-two primary care physical therapists attended an 8-day
university course (over 8 weeks) aimed at identifying and addressing psychosocial
risk factors. INTERVENTION: The physical therapists were randomly assigned to
either the course or a waiting list. They treated consecutive patients with acute
and subacute musculoskeletal pain both before and after the course. MEASUREMENTS:
We measured physical therapists' attitudes and beliefs about psychosocial
factors, knowledge, and skills before and after the course. We measured patients'
pain, disability, catastrophizing, and mood at the start of treatment and at a
6-month follow-up. METHODS: The physical therapists were randomly assigned to
either the course or a waiting list. They treated consecutive patients with acute
and subacute musculoskeletal pain both before and after the course. RESULTS: Pain
and disability outcomes in all patients of physical therapists who had
participated in the course or in patients at risk of developing long-term
disability who had higher levels of catastrophizing or depression were not
significantly different from those outcomes in patients of physical therapists
who had not participated in the course. Pain and disability outcomes in patients
with a low risk of developing long-term disability-and pain outcomes in patients
with a high risk of developing long-term disability-were not dependent upon
whether the attitudes and beliefs of their physical therapists changed during the
course. However, disability outcomes in patients with a high risk of developing
long-term disability may have been influenced by whether the attitudes and
beliefs of their physical therapists changed. LIMITATIONS: A limitation of this
study was that actual practice behavior was not measured. CONCLUSIONS: An 8-day
university course for physical therapists did not improve outcomes in a group of
patients as a whole or in patients with a risk of developing long-term disability. However, patients who had a risk of developing long-term disability
and had higher levels of catastrophizing or depression may have shown greater
reductions in disability if the attitudes and beliefs of their physical
therapists changed during the course.

Langue : ANGLAIS