Background & Aims

When treating health experience and outcomes, there has been increasing interest in interventions that incorporate exercise and psychological treatments, that is, cognitive behavioral therapy (CBT) 1. Also, there is growing interest in physical therapists performing interventions that integrate exercise and psychosocial components. And there is increasing recognition of the benefits of incorporating the biopsychosocial model of health within physical therapist practice 2.
Since multidisciplinary treatment for chronic pain had been backward in Japan for a long time, the Ministry of Health, Labour and Welfare (MHLW) encouraged an expert panel to build multidisciplinary pain centers in Japan. As a result, 37 pain centers have been established in the past decade.
This survey aims to investigate how physical and occupational therapists integrate rehabilitation and psychosocial components in their daily practice at the multidisciplinary pain centers in Japan.

Methods

The subjects were physical and occupational therapists (PT, OT) providing rehabilitation to patients with chronic pain at 37 multidisciplinary pain centers in Japan. The survey method was to request each center by e-mail, and each therapist responded directly to the questionnaire of a response form on the Internet. The questionnaire included basic information of the therapists and following items regarding CBT: 1) level of knowledge, 2) effectiveness, 3) need for knowledge, 4) number of patients for whom CBT is indicated, 5) the methodology used for treatment, and 6) image of CBT. A single correlation analysis was conducted with question items 1-4, that had positive implications for CBT, and subject characteristics. In addition, a principal component analysis was conducted using question items 1-4. Subsequently, multiple regression analysis was performed with the derived principal components as the dependent variables and subject characteristics as the independent variables.

Results

The number of valid responses was 77. The number of years worked at the pain center was 5.9±4.0 years. Only 36% of the respondents had applied CBT, 47% had not applied it but knew about it, and 17% did not know much or nothing about it. The type of CBT done were rehabilitation using CBT theory (74.0%), pacing (63.6%), and relaxation (55.8%), with acceptance & commitment and mindfulness very little. The 66% of respondents indicated that more than half of the patients undergoing rehabilitation needed CBT. In addition, more than 60 % said that CBT is effective, and 95% said that knowledge of CBT is necessary for PT and OT working at the pain centers. On the other hand, many therapists answered that the image of CBT was “difficult”.
The results of the single correlation analysis showed a correlation between length of time working at the pain centers (LOT) and knowledge/ experience (K/E) of CBT and perceived effectiveness of CBT. Moreover, K/E of CBT was correlated with LOT.

Conclusions

The survey indicated that only 36% of therapists at the multidisciplinary pain centers in Japan perform therapies that integrate CBT and rehabilitation. On the other hand, there were many patients who need CBT, and most therapists recognized the need for CBT knowledge. Despite this, the characteristics of therapists who have not incorporated CBT in their daily practice include limited experience treating chronic pain patients in the pain centers and older age. In addition, given that many therapists found that CBT was difficult, it should be necessary to actively educate young therapists and trainees about CBT in order to incorporate CBT into rehabilitation at the pain center in Japan.

References

1. Keefe FJ, Somers TJ. Psychological approaches to understanding and treating arthritis pain. Nat Rev Rheumatol. 2010; 6(4):210-216.
2. Simpson P, Holopainen R, Schütze R, et al. Training of Physical Therapists to Deliver Individualized Biopsychosocial Interventions to Treat Musculoskeletal Pain Conditions: A Scoping Review. Phys Ther. 2021; 101(10):pzab188.
3. Nielsen M, Keefe FJ, Bennell K, et al. Physical therapist-delivered cognitive-behavioral therapy: a qualitative study of physical therapists’ perceptions and experiences. Phys Ther. 2014; 94(2):197-209.
4. Hunt MA, Keefe FJ, Bryant C, et al. A physiotherapist-delivered, combined exercise and pain coping skills training intervention for individuals with knee osteoarthritis: a pilot study. Knee. 2013;20(2):106-112.

Presenting Author

Yukiko Shiro

Poster Authors

Yukiko Shiro

PT

Nagoya Gakuin University

Lead Author

Young-Chang Arai

Multidisciplinary Pain Center, Aichi Medical University

Lead Author

Yuichiro Nakaso

PT

Department of Pain Medicine, Aichi Medical University

Lead Author

Tatsunori Ikemoto

MD

Department of Orthopedics, Aichi Medical University

Lead Author

Takahiro Ushida

Multidisciplinary Pain Center, Aichi Medical University

Lead Author

Topics

  • Treatment/Management: Pharmacology: Psychological and Rehabilitative Therapies