Motivational Enhancement Therapy in Addition to Physical Therapy Improves Motivational Factors and Treatment Outcomes in People With Low Back Pain: A Randomized Controlled Trial

doi:10.1016/j.apmr.2010.10.016

Archives of Physical Medicine and Rehabilitation

Volume 92, Issue 2, February 2011, Pages 176-183

https://doi.org/10.1016/j.apmr.2010.10.016 Get rights and content

Abstract

Vong SK, Cheing GL, Chan F, So EM, Chan CC. Motivational enhancement therapy in addition to physical therapy improves motivational factors and treatment outcomes in people with low back pain: a randomized controlled trial.

Objectives

To examine whether the addition of motivational enhancement treatment (MET) to conventional physical therapy (PT) produces better outcomes than PT alone in people with chronic low back pain (LBP).

Design

A double-blinded, prospective, randomized, controlled trial.

Setting

PT outpatient department.

Participants

Participants (N=76) with chronic LBP were randomly assigned to receive 10 sessions of either MET plus PT or PT alone.

Intervention

MET included motivational interviewing strategies and motivation-enhancing factors. The PT program consisted of interferential therapy and back exercises.

Main Outcome Measures

Motivational-enhancing factors, pain intensity, physical functions, and exercise compliance.

Results

The MET-plus-PT group produced significantly greater improvements than the PT group in 3 motivation-enhancing factors; proxy efficacy (P<.001), working alliance (P<.001), and treatment expectancy (P=.011). Furthermore, they performed significantly better in lifting capacity (P=.015), 36-Item Short Form Health Survey General Health subscale (P=.015), and exercise compliance (P=.002) than the PT group. A trend of a greater decrease in visual analog scale and Roland-Morris Disability Questionnaire scores also was found in the MET-plus-PT group than the PT group.

Conclusion

The addition of MET to PT treatment can effectively enhance motivation and exercise compliance and show better improvement in physical function in patients with chronic LBP compared with PT alone.

Section snippets

Participants

People with chronic LBP were recruited consecutively from a local outpatient PT department. Inclusion criteria were people aged 18 to 65 years for whom LBP had been diagnosed for at least 3 months. Exclusion criteria were people who were pregnant or had a cardiac pacemaker, pain from neurologic disorders or rheumatologic disease, consistent symptoms of sciatica, spondylolisthesis more than lcm, received PT for LBP in the past 3 months, psychiatric problems, or received compensation for

Baseline Characteristics

Eligible patients (N=88) initially were recruited for the present study and were randomly assigned to either the MET-plus-PT (n=45) or PT group (n=43). However, before the study began, 12 patients refused to participate for medical reasons or time conflicts. No significant differences for demographic data were found between dropout subjects and participants. Therefore, 76 subjects participated in the present study (fig 1). Their baseline characteristics are listed in table 1. No significant

Discussion

MET is a relatively new intervention used in pain management. Our findings showed that the addition of MET to conventional PT produced significantly better motivation outcomes, physical capacities, self-perceived general health, and compliance in performing home exercise than in the PT group. No adverse effect or harm was reported in either group. Of the very few MET-related studies of chronic LBP,20, 23, 36, 46 this is the only one that found significant motivational outcomes for the

Conclusions

We found that the integrated MET-plus-PT treatment produced significantly higher motivational status during the study period than PT-alone for patients with chronic LBP. This integrated intervention also produced significantly greater improvements in lifting capacity, self-perceived GH, and compliance with exercise up to 1-month follow-up.

Acknowledgments

We thank C.C. Lam and the physical therapists of the outpatient PT department in the Princess Margaret Hospital for support throughout this study.

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It is now increasingly common for registered nurses (RNs) and PTs to use CBT techniques with patients who have musculoskeletal conditions (Urits et al., 2019; Hall et al., 2018; Moseley et al., 2015). Research has shown that psychological interventions, such as health coaching based on CBT principles, can be advantageous for improving health outcomes, reducing pain-related disability, and enhancing quality of life for patients with LBP (Cherkin et al., 2017, 2016; Huber et al., 2017; Kamper et al., 2015; Williams et al., 2012; Carpenter et al., 2012; Hoffman et al., 2007; Buhrmann et al., 2004) and when added to standard conservative rehabilitation (Hajihasani et al., 2019; Marin et al., 2017; Mannion et al., 2013; Froholdt et al., 2012; Vong et al., 2011; Brox et al., 2006, 2003). Telephonic and digitally based coaching and educational services for pain management have demonstrated promising results when incorporated into the multidisciplinary treatment of LBP (Toelle et al., 2019; Huber et al., 2017; Buhrman et al., 2004).
A remotely delivered cognitive behavioral coaching (CBC) program was offered as a service benefit for commercial health plan members with low back pain (LBP). This study describes changes in self-rated functional disability in a sample of plan members participating in the program (N=423).
Independent measures included demographics, length of program enrollment, total CBC sessions, and baseline self-reported patient activation and presenteeism levels. Participants rated their functional disability level due to LBP using the Oswestry Disability Index (ODI). Dependent outcomes quantified change in participant functional disability rating (final ODI score minus baseline ODI score). Nonparametric tests compare differences between groups and within-group ODI score change. Two generalized linear models test for associations between independent variables and the ODI change score.
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Original articleMotivational Enhancement Therapy in Addition to Physical Therapy Improves Motivational Factors and Treatment Outcomes in People With Low Back Pain: A Randomized Controlled Trial

Abstract

Objectives

Design

Setting

Participants

Intervention

Main Outcome Measures

Results

Conclusion

Section snippets

Participants

Baseline Characteristics

Discussion

Conclusions

Acknowledgments

Lancet

Patient Educ Couns

Pain

Pain

J Pain

Arch Phys Med Rehabil

Eur J Pain

Arch Phys Med Rehabil

Eur J Pain

Pain

Hong Kong Physiother J

Patient Educ Couns

J Pain

Epidemiology of low back pain in children and adolescents

Arch Dis Child

The role of alternative medical providers for the outpatient treatment of insured patients with back pain

Spine

Primary care: low back pain

N Engl J Med

Incidence and course of low back pain episodes in the general population

Spine

Active exercise, education, and cognitive behavioral therapy for persistent disabling low back pain: a randomized controlled trial

Spine

Prediction of success from a multidisciplinary treatment program for chronic low back pain

Spine

Tailoring cognitive-behavioral therapy for chronic pain: a case example

J Clin Psychol

Enhancing motivation to change in pain treatment

Introduction to the study of motivation

Motivational interviewing in health care: helping patients change behavior

Motivational interviewing with problem drinkers

Behav Psychother

Motivational beliefs, values, and goals

Annu Rev Psychol

What is motivational interviewing?

Behav Cogn Psychother

Original article
Motivational Enhancement Therapy in Addition to Physical Therapy Improves Motivational Factors and Treatment Outcomes in People With Low Back Pain: A Randomized Controlled Trial