Journal article
Cognitive-Behavioral-Based Physical Therapy for Improving Recovery After a Traumatic Lower-Extremity Injury
Journal of bone and joint surgery. American volume, Vol.106(14), pp.1300-1308
07/17/2024
DOI: 10.2106/JBJS.23.01234
PMID: 38781313
Abstract
Background:Lower-extremity injuries can result in severe impairment and substantial years lived with a disability. Persistent pain and psychological distress are risk factors for poor long-term outcomes and negatively influence the recovery process following a traumatic injury. Cognitive-behavioral therapy (CBT) interventions have the potential to address these risk factors and subsequently improve outcomes. This study aimed to evaluate the effect of a telephone-delivered cognitive-behavioral-based physical therapy (CBPT) program on physical function, pain, and general health at 12 months after hospital discharge following lower-extremity trauma. The CBPT program was hypothesized to improve outcomes compared with an education program.Methods:A multicenter, randomized controlled trial was conducted involving 325 patients who were 18 to 60 years of age and had at least 1 acute orthopaedic injury to the lower extremity or to the pelvis or acetabulum requiring operative fixation. Patients were recruited from 6 Level-I trauma centers and were screened and randomized to the CBPT program or the education program early after hospital discharge. The primary outcome was the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF) scale. The secondary outcomes were objective physical function tests (4-square step test, timed stair ascent test, sit-to-stand test, and self-selected walking speed test), PROMIS Pain Intensity and Pain Interference, and the Veterans RAND 12-Item Health Survey. Treatment effects were calculated using targeted maximum likelihood estimation, a robust analytical approach appropriate for causal inference with longitudinal data.Results:The mean treatment effect on the 12-month baseline change in PROMIS PF was 0.94 (95% confidence interval, -0.68 to 2.64; p = 0.23). There were also no observed differences in secondary outcomes between the intervention group and the control group.Conclusions:The telephone-delivered CBPT did not appear to yield any benefits for patients with traumatic lower-extremity injuries in terms of physical function, pain intensity, pain interference, or general health. Improvements were observed in both groups, which questions the utility of telephone-delivered cognitive-behavioral strategies over educational programs.Level of Evidence:Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
Details
- Title: Subtitle
- Cognitive-Behavioral-Based Physical Therapy for Improving Recovery After a Traumatic Lower-Extremity Injury
- Creators
- Kristin R. Archer - Vanderbilt UniversityKatherine P. Frey - Johns Hopkins UniversityDana Alkhoury - Johns Hopkins UniversityNicole Hada - Johns Hopkins UniversityJoshua F. Betz - Johns Hopkins UniversityWilliam Obremskey - Vanderbilt UniversityGerard Slobogean - University of Maryland, BaltimoreDanielle H. Melton - The University of Texas Health Science Center at HoustonJason M. Wilken - University of IowaMadhav A. Karunakar - Carolinas Medical CenterJessica C. Rivera - San Antonio Military Medical CenterHassan Mir - Florida Orthopaedic InstituteTodd O. McKinley - Indiana UniversityRenan C. Castillo - Johns Hopkins UniversityStephen T. Wegener - Johns Hopkins UniversityMajor Extremity Trauma Research Consortium (METRC)
- Resource Type
- Journal article
- Publication Details
- Journal of bone and joint surgery. American volume, Vol.106(14), pp.1300-1308
- Publisher
- Lippincott Williams & Wilkins
- DOI
- 10.2106/JBJS.23.01234
- PMID
- 38781313
- ISSN
- 0021-9355
- eISSN
- 1535-1386
- Number of pages
- 9
- Language
- English
- Date published
- 07/17/2024
- Academic Unit
- Physical Therapy and Rehabilitation Science
- Record Identifier
- 9984691559102771
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