Investigating psychological treatment

Chief Investigator:

Prof Elaine Hay

Principal Investigator:

Dr Jonathan Hill

Funder name / reference number: National Institute for Health Research (NIHR)
Year Over 5 years

Study design

Investigating psychological treatment mediators of musculoskeletal pain interventions

i: Secondary analysis of qualitative and quantitative data from the BeBack study to explore factors relevant to changes in patients’ perceptions about LBP and identify which psychological predictors were potential mediators of 6-month disability outcome.

ii: A literature review summarized available evidence regarding psychological treatment targets and best practice methods of mediation analysis.

iii: Mediation analysis (structural equation modelling) was conducted using existing data from the STarT Back trial ( n=851), to test if psychologically informed physiotherapy successfully targeted psychological distress in patients at high-risk of poor outcome.

iv: Interviews with GPs (n=32) and physiotherapists (n=32) from the IMPaCT Back implementation study were re-analysed to explore clinician’s attitudes towards treating patients with LBP and explore challenges for assessing and managing patients’ perceptions.

Primary objective

This project investigated how best to design studies to address psychological factors that mediate outcome in primary care for people with back pain receiving psychological treatment.

Secondary analysis of potential mediating factors in RCTs suggests that specific targeting of psychological factors during treatment and the inclusion of more homogeneous populations allow for a stronger mediating effect. The research has published clear recommendations for future clinical trial designs to better optimise embedded mediation studies to confirm the mechanisms of treatment outcome in this field.