Feasibility of the biopsychosocial primary care intervention ‘Back on Track’ for patients with chronic low back pain: a process and effect-evaluation

Figures & data

Table 1. Overview of measurement instruments used to assess the feasibility and effect evaluation elements.

Element	CEQ questionnaire PT	CEQ questionnaire patients	Attendance list patients	Audio recordings	Evaluation form patients	Focus group physicians	Focus group PT	QBPDS questionnaire
Feasibility
Credibility & expectancy	x	x				x	x
Reach			x
Fidelity Dose delivered				x	x	x	x
Dose received					x	x	x
Recruitment						x	x
Context						x	x
Effectiveness
Effect								x

PT: physiotherapist; CEQ: Credibility and Expectancy Questionnaire; QBPDS: Quebec Back Pain Disability Scale.

Figure 1. Flow chart of the study participants (patients).

Table 2. Baseline characteristics of study participants (patients).

	Back on Track intervention (n = 18)
	mean/frequency (SD/%)
Age (years)^a	49 (18–59)
Sex (female)	13 (72%)
Nationality
Dutch	16 (89%)
Other	2 (11%)
Education level
Low	9 (50%)
Middle	7 (39%)
High	2 (11%)
Employment
Full-time	2 (11%)
Part-time	1 (6%)
Full-time education	2 (11%)
Voluntary work	8 (44%)
Unemployed	5 (28%)
Duration of low back pain (since first onset)
3–6 months	1 (6%)
6–12 months	3 (17%)
1–2 years	2 (11%)
2–5 years	7 (39%)
>5 years	5 (28%)
Functional disability (QBPDS)	42 (14.0)
Functional disability (PDI)	33 (10.6)
Pain intensity (NRS)^a	6 (2–10)
Pain catastrophizing (PCS)	21 (8.3)
Anxiety and Depression (HADS)
Anxiety^a	6 (1–20)
Depression^a	5 (1 − 14)
Physical functioning (RAND-36, subscale)	50 (15.3)
Mental health (RAND-36, subscale)	66 (18.1)
Pain self-efficacy (PSEQ)	37 (9.9)
Kinesiophobia (TSK)	37 (5.9)

QBPDS: Quebec Back Pain Disability Scale (0–100); PDI: Pain Disability Index (0–70); NRS: Numeric Rating Scale (0–10), average pain last week; PCS: Pain Catastrophizing Scale (0–52); HADS: Hospital Anxiety and Depression Scale (0–21 per subscale); RAND-36: RAND-36 item Health Survey (0–100 per subscale); PSEQ: Pain Self Efficacy Questionnaire (0–60); TSK: Tampa Scale for Kinesiophobia (17–68).

^aData is presented as median (range) due to the asymmetric distribution.

Table 3. Attendance rates and mean satisfaction by patients per session of the Back on Track intervention.

Session	Attendance rate	Satisfaction rating
	n (%)	Mean ± SD (n)
Individual session 1	18 (100%)	7.6 ± 1.0 (n = 11)
Individual session 2	18 (100%)	7.2 ± 0.9 (n = 11)
Individual session 3	16 (89%)	7.6 ± 1.2 (n = 10)
Theme 1, session 1	13 (72%)	7.3 ± 1.5 (n = 7)
Theme 1, session 2	12 (67%)	6.3 ± 2.9 (n = 7)
Theme 2, session 1	11 (61%)	7.5 ± 1.5 (n = 6)
Theme 2, session 2	12 (67%)	6.3 ± 2.9 (n = 7)
Theme 3, session 1	12 (67%)	6.6 ± 2.0 (n = 8)
Theme 3, session 2	11 (61%)	7.4 ± 1.3 (n = 7)
Theme 4, session 1	10 (56%)	7.2 ± 1.0 (n = 6)
Theme 4, session 2	6 (33%)	5.8 ± 3.9 (n = 4)
Individual session 4	10 (56%)	6.5 ± 3.4 (n = 6)
Individual consultation physician	11 (61%)	5.4 ± 4.0 (n = 7)

Table 4. Percentage of elements achieved during therapy sessions according to the ratings of audio recordings.

Session	Item	Element	Not achieved (%)	Partially achieved (%)	Satisfactorily achieved (%)
Individual 1-3	Aim of intervention is explained (improving functional disability level + coping style)	EU	6	6	88
Individual 1-3	Pain education is provided	EU	0	6	94
Individual 1-3	Pain-consequence model is discussed	EU	0	13	88
Individual 1-3	Patient specific functional activities are defined	EU	0	0	100
Individual 1-3	SMART goals are set	EU	0	14	86
Theme 1	Short- and long term consequences of pain behaviour are discussed	EU	17	33	50
Theme 1	Graded Activity principles are discussed	EU	0	33	67
Theme 1	Disadvantages of pain behaviour are discussed	EU	0	17	83
Theme 1	The aim of Graded Activity is discussed	EU	0	17	83
Theme 1	The baseline activity level of the patient is discussed	EU	0	0	100
Theme 1	A Graded Activity plan is defined	EU	0	0	100
Theme 1 + 2 + 4	Vicious circle is discussed (influence of negative thoughts)	EU	11	33	56
Theme 2	The coping style of patient is discussed	EU	0	17	83
Theme 2	The coping style of environment (family/work) is discussed	EU	0	0	100
Theme 2	Factors that influence behaviour change are discussed	EU	0	33	67
Theme 3	Concerns/fear regarding activities is discussed (e.g. using the PHODA)	EU	0	33	67
Theme 3	The level of perceived threat value of daily activities is defined	EU	17	33	50
Theme 4	Facts and myths about chronic (low) back pain are discussed	EU	0	17	83
Theme 4	The influence of positive and negative thoughts and emotions are discussed	EU	0	0	100
Individual 4	To what extent the patient has insight into the influencing psychosocial factors is discussed	EU	17	33	50
Individual 4	To what extent the patient has insight into self-management strategies to improve the level of activities is discussed	EU	0	33	67
Individual 4	Future policy is discussed/defined	EU	0	17	83
Individual 1-3	The therapist goes into the chronic pain symptoms (existence, course, status praesens), level of activity and participation, previous treatments and/or diagnosis	E	0	0	100
All	The patient is actively involved during the therapy	E	0	15	85
Individual 4	Patient’s experiences with the intervention are discussed	E	0	17	83
Individual 4	Patient’s status and improvement during the intervention is discussed	E	0	33	67
All	It is discussed that decreasing pain is not a goal of the intervention	U	28	15	57
All	The therapist elicits influencing cognitions, feelings, emotions regarding pain or activities	U	4	20	76
Theme 3	Important factors are discussed that influenced exposure to fearful activities (e.g. safety behaviour, verbal expression)	U	33	33	33
Individual 1-3 Theme 1-4	Fear/concern with regard to pain or activities is expressed by the therapist^a	P	91	7	2
All	Medical diagnoses are used to explain or justify the decreased level of daily life functioning (except for pain physiology)^a	P	85	13	2

EU: essential and unique; E: essential but not unique; U: unique but not essential; P: prohibited; PHODA: Photograph Series of Daily Activities, measurement instrument to identify the perceived harmfulness of daily activities by patients [23].

^aFor these items, it is desirable to have high percentages ‘not achieved’ (i.e. did not occur).

Table 5. Estimates of improvements in functional disability at post-treatment and 3 months post-treatment.

	Mean change score from baseline^a (95% CI)	p Value
	n = 18
QBPDS (points)
Post-treatment	−8.3 (−13.9 to −2.7)	.006
3 months	−7.6 (−12.9 to −2.2)	.009

^aBaseline QBPDS was 42 (14.0).

Leeuw M, Goossens ME, van Breukelen GJ, et al. Measuring perceived harmfulness of physical activities in patients with chronic low back pain: the Photograph Series of Daily Activities–short electronic version. J Pain: 2007;8(11):840–849.

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