A research team at Intermountain Healthcare’s Physical Therapy will study interventions for chronic lower back pain as part of a national, multi-site study that has been approved for a $14 million funding award from the Patient-Centered Outcomes Research Institute (PCORI).
Gerard Brennan , PT, PhD, Director of Clinical Quality and Outcomes Research, Intermountain Rehabilitation Services, will serve as the principal investigator (PI) for the Intermountain site. The national, multi-site study will be led by Antony Delitto, Ph.D., of the University of Pittsburgh.
The five-year award from the Patient-Centered Outcomes Research Institute (PCORI) will fund a study to examine the transition from acute lower back pain to chronic lower back pain, and compare two approaches that can be delivered in a primary care office. The first approach allows physicians to do what they think is best, which is termed “usual care.” The second approach teams up physicians with physical therapists to deliver cognitive behavioral therapy, a specialized therapy designed to help patients put their lower back pain in perspective, allowing them to identify and overcome barriers to recovery.
Intermountain Healthcare will receive $2.4 million to conduct research focusing on targeted interventions to prevent chronic lower back pain in high risk patients. According to The American Academy of Pain Medicine, more than 100 million Americans suffer from some sort of chronic pain, and lower back pain is the leading cause of disability in Americans under 45 years old. More than 26 million Americans between the ages of 20-64 experience frequent back pain.
“This is a wonderful award and my greatest hope is that the project helps physical therapists and primary care physicians to understand better how to improve care for patients recovering from low back pain,” said Dr. Brennan. “Intermountain Healthcare’s sincere belief in our mission, the clinical leadership of people like Stephen Hunter, DPT, Mark Briesacher, MD, and Wayne Cannon, MD, and our sustained commitment to quality and doing what is best for patients is what builds relationships with funding agencies like PCORI and strategic partners like the University of Pittsburgh.”
The multi-site study will recruit 60 primary-care clinics affiliated with UPMC, Intermountain Healthcare, Johns Hopkins Hospital and Health System, Boston Medical Center and The Medical University of South Carolina. At each site, 12 primary-care clinics will be randomly assigned to one of two study arms: the usual care their physician would prescribe for lower back pain or primary care coupled with physical and cognitive behavioral therapy.
Across the five regional sites, the team expects to recruit 2,640 patients with acute lower back pain, which is defined as pain they feel less than half the time and have had for less than 6 months. These patients will be evaluated with a standardized test that characterizes their response to pain and their predisposition to psychosocial characteristics that cause them to avoid pain out of fear.
The study will compare a patient-centered outcome that asks how well the patients perform activities that typically bother people with lower back pain, such as sitting, standing, walking, lifting, traveling and sleeping. Finally, the research team will measure the number of X-rays, MRIs, surgery and other lower back-related medical procedures for all patients enrolled in the study.
The national study approved for PCORI funding was selected through a highly competitive review process in which patients, caregivers, and other stakeholders joined scientists to evaluate the proposals. Applications were assessed for scientific merit, how well they will engage patients and other stakeholders, and their methodological rigor among other criteria.
The award has been approved pending completion of a business and programmatic review by PCORI staff and issuance of a formal award contract.