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Physiotherapy informed by Acceptance and Commitment Therapy for chronic low back pain: A mixed‐methods treatment fidelity evaluation
Author(s) -
Galea Holmes Melissa N.,
Wileman Vari,
Hassan Shaira,
Denning Julie,
Critchley Duncan,
Norton Sam,
McCracken Lance M.,
Godfrey Emma
Publication year - 2022
Publication title -
british journal of health psychology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.05
H-Index - 88
eISSN - 2044-8287
pISSN - 1359-107X
DOI - 10.1111/bjhp.12583
Subject(s) - pact , receipt , alliance , randomized controlled trial , physical therapy , competence (human resources) , fidelity , medicine , psychology , social psychology , surgery , electrical engineering , archaeology , world wide web , computer science , political science , law , history , engineering
Objectives A randomized controlled trial of a new type of Physiotherapy informed by Acceptance and Commitment Therapy (PACT), found that it improved functioning in people with chronic low back pain compared to usual physiotherapy care. Fidelity evaluation is necessary to understand trial processes and outcomes. This study evaluated PACT treatment fidelity including delivery, receipt, and enactment. Design A mixed‐methods study nested within a randomized controlled trial was conducted. Methods A total of 72 (20% of total) PACT treatment audio files were independently assessed by two raters, according to a novel framework developed to measure PACT treatment content adherence, therapeutic alliance, ACT competence, and treatment enactment. Interview transcripts from 19 trial participants randomized to PACT were analysed thematically for evidence of treatment receipt and enactment. Results PACT physiotherapists delivered treatment as intended with high content adherence and satisfactory therapeutic alliance, but ACT competence was low. Qualitative findings indicated participant receipt of 11/17 and enactment of 3/17 components; 89% ( n = 17) and 47% ( n = 9) of participants reported treatment receipt and enactment of at least one component, respectively. Conclusions This mixed‐methods study of PACT treatment demonstrated high fidelity reflecting treatment content delivery and receipt, and therapeutic alliance. There was some evidence of treatment enactment in participants with chronic low back pain. Low ACT competence could be addressed through additional support and adaptations to therapeutic processes for delivery by physiotherapists.