Advancing Psychologically Informed Practice for Patients With Persistent Musculoskeletal Pain: Promise, Pitfalls, and Solutions.
Francis J Keefe, Chris J Main, Steven Z George
PMID 29669084WHAT IT FOUND
This perspective describes psychologically informed practice for persistent musculoskeletal pain.
It details therapist training steps like manuals and supervision, and lists techniques such as reinforcement and patient-centered interviewing. No new patient outcomes are reported.
Key findings
01The authors recommend a three-step hierarchical training approach for therapists delivering psychologically informed practice, consisting of a treatment manual, an experiential workshop, and ongoing supervision.
02Effective therapist reinforcement involves delivering reward immediately after a target behavior, phasing down the rate of reinforcement over time to reduce dependency, and focusing on successful behaviors rather than problematic ones.
03Psychologically informed practice is currently focused primarily on low back pain, with applications to other musculoskeletal conditions like neck, shoulder, and knee pain still in early stages.
STILL TO COME
How it was doneWhat it means for PTs
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What it does not show
This is a narrative review and perspective, so it does not provide a systematic synthesis of evidence or new outcome data. The focus is almost exclusively on low back pain, with limited information on other musculoskeletal conditions. The recommendations for training and implementation are based on author opinion and general literature, not on a specific trial testing these training methods.
Declared interests
Steven Z. George was supported by a grant from the National Institute for Arthritis and Musculoskeletal and Skin Diseases. The funder played no role in writing the perspective. The authors reported no conflicts of interest.
The easy way to misread this
Do not interpret the described techniques, such as therapist reinforcement or patient-centered interviewing, as proven interventions for persistent pain based on this paper alone. This is a perspective article summarizing the concept of psychologically informed practice; it does not report results from a trial testing these specific methods against a control group.