The Implementation of Psychologically Informed Physical Therapy to Prevent Chronification in Service Members with Musculoskeletal Disorders
Abstract
Disability due to musculoskeletal disorders (MSD) poses a major problem for the Navy. Research has shown that once a Service member has been injured, negative thoughts and feelings about the injury can increase the likelihood of disability. Treatments designed to identify and address these thoughts and feelings (or psychological factors) have been successful in improving outcomes; however, these treatments are often provided by mental health professionals late in an episode. There is evidence that early treatment may be more successful at reducing disability and that perhaps this type of treatment should be provided by physical therapists who have early and prolonged access to patients. However, current physical therapy training does not address the identification and management of psychological factors. Therefore, we have developed a course to train physical therapists to identify and address psychological factors that increase the likelihood of disability in patients with MSD. This approach to rehabilitation is called Psychologically informed Physical Therapy (PiPT). In a pilot study, we demonstrated successful implementation of training physical therapists onboard an aircraft carrier to deliver PiPT to active duty Service members (ADSM) with MSD. The long-term objective of our research is to implement this training program in different settings and for different patients with MSD throughout the military. In the proposed study, we aim to establish the feasibility of implementing PiPT in a US Navy shore-based healthcare facility. We will also assess the impact of PiPT on ADSM with MSD in comparison to usual physical therapy. We have developed and piloted a training program for Navy physical therapists that outlines how to address important psychological factors during treatment and how to recognize when to refer a patient to a mental health professional for further evaluation and treatment. By testing our training program in a new setting, we will be able to ascertain how training needs of physical therapists differ across settings in the Navy. This will help us to adapt a standardized training program for all Navy physical therapy personnel, further advancing their skills for the delivery of high-quality care to Service members. All Service members with MSDs may potentially benefit from the findings of this study, especially those who are at risk of developing chronicity. The delivery of PiPT has many foreseeable benefits including reduced disability and improved quality of life. In the long run, it has the potential to reduce the need for ongoing healthcare utilization. PiPT also enhances communication between the therapist and the patient, increasing patient satisfaction and improving self-efficacy. There are no foreseeable risks of this intervention. Findings from the proposed study have the potential to impact the military beyond Service members with MSD. Reduced chronicity in ADSM with MSD may lead to improvements in attrition, lost man hours, and the number of ADSM unable to deploy as a result of their injury. A healthy workforce is important to the overall mission of enhancing military readiness. Furthermore, military families stand to benefit from the health and wellbeing of their primary income earners. As all ADSM eventually transition to become Veterans, effectively preventing chronicity in ADSM with MSD may have a long-term effect on the health of Veterans and the ultimate cost of Veteran health care.
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Mar 10, 2021
- Source ID
- W81XWH2020036
Entities
People
- Marco A Campello
Organizations
- Grossman School of Medicine
- United States Army