Results Summary and Professional Abstract
|This project's final research report is expected to be available by September 2021.|
|Article Highlight: This PCORI-funded study aimed to test whether a risk-stratified approach to treatment in primary care settings would result in lower rates of patients with acute back pain developing chronic back pain. To assess chronic pain risk, the team asked patients questions about how they were coping with back pain and assigned them to either low-, medium-, or high-risk groups. Patients who scored high risk were placed into two groups: usual care or usual care plus psychologically informed physical therapy, which also teaches patients coping skills to manage back pain. As reported in EClinicalMedicine, among patients at high risk, 50 percent developed chronic back pain regardless of type of care, while 20 percent of low-risk and 33 percent of medium-risk patients developed chronic low back pain.|
Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.
The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments.
Peer reviewers commented and the researchers made changes or provided responses. Those comments and responses included the following:
- The reviewers asked for more information on what interventions patients received during physical therapy. The researchers stated that they did not have this information because they designed the study pragmatically, focusing on training physical therapists in psychologically-informed physical therapy (PIPT), and providing a checklist to remind physical therapists about this model. Therefore, the researchers did not measure adherence to PIPT.
- The reviewers asked whether PIPT-trained physical therapists treated any patients in the usual care group and vice versa, since physical therapists in the referral area of the intervention primary care clinics received the PIPT training but were not limited to only seeing patients from the intervention primary care clinics. The researchers acknowledged that they did not have a way to match up PIPT-trained physical therapists with intervention group patients only, nor could they check to see if these physical therapists treated any patients in the usual care group.
- The reviewers questioned the references to the care practices in the control group as guideline-based care, given the variability of those care practices and how often the treatment for low-back pain was not in line with current care guidelines. The researchers explained that they had been encouraged to use guideline-based care to more specifically describe the expected interventions in the control group but agreed that the term usual care better described the variability of clinical practices in the control group. Although the researchers had been told that usual care would not be a specific enough comparator, the reviewers felt that usual care was an appropriate control group in a pragmatic trial.
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