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Physical therapy informed by Acceptance and Commitment Therapy (PACT) versus usual care physical therapy for adults with chronic low back pain: a randomised controlled trial

Research output: Contribution to journalArticle

Original languageEnglish
JournalThe Journal of Pain
Early online date5 Jun 2019
Publication statusE-pub ahead of print - 5 Jun 2019


King's Authors


Chronic low back pain (CLBP) is a major cause of global disability and improving management is essential. Acceptance and Commitment Therapy (ACT) is a promising treatment for chronic pain but has not been modified for physical therapy. This randomized controlled trial (RCT) compared physical therapy informed by Acceptance and Commitment Therapy (PACT) against standard care physical therapy for patients with CLBP. Patients with CLBP (duration ≥12 weeks, mean 3 years) were recruited from physical therapy clinics in four UK public hospitals. The Roland-Morris Disability Questionnaire (RMDQ) at 3 months’ post randomization was the primary outcome. 248 participants (59% female, mean age=48) were recruited and 219 (88·3%) completed measures at 3 and/or 12 months’ follow-up. At 3 months, PACT participants reported better outcomes for disability (RMDQ mean difference =1·07, p=0·037, 95%CI -2·08 to -0·07, d=0·2), Patient Specific Functioning (p=0.008), SF12 physical health (p=0.032), and treatment credibility (p<0.001). At 12 months’ follow-up there were no significant differences between groups. PACT was acceptable to patients and clinicians and feasible to deliver. Physical therapists incorporated psychological principles successfully and treatment was delivered with high (≥80%) fidelity. Our results may inform the management of CLBP, with potential benefits for patients, health care providers and society.

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