Pilot Study of an Innovative Model to Provide Multi-modal Cognitive Behavioral Theory-Informed Physical Therapy (CBT-PT) for Neck and Back Pain in the Emergency Department

Neck and back pain are very common reasons for emergency department (ED) visits. Despite evidence of only modest effectiveness and significant safety risks, treatment is frequently limited to opioid and non-opioid medications. Cognitive Behavioral Theory-Informed Physical Therapy (CBT-PT) combines CBT-based pain coping skills training (e.g., relaxation techniques, activity pacing) with PT assessment and treatment as a multi-modal nonpharmacologic intervention, which has been shown to improve pain in outpatient settings. This pilot study assessed the feasibility, acceptability, and preliminary effects of CBT-PT for ED patients presenting with neck and/or back pain. We enrolled a convenience sample of adult patients presenting with neck and/or back pain to an urban tertiary care ED in North Carolina (80,000 ED visits per year). We used a two-arm prospective cohort design with assignment to (1) CBT-PT intervention or (2) control, based on physical therapist availability. Both groups received usual care for pain at the discretion of their ED provider. Feasibility was assessed with enrollment rate; acceptability was assessed with patient satisfaction on a 5-point Likert scale; and preliminary effects were measured with pain numeric rating scores (0-10 NRS) and PROMIS-29 physical function and pain interference scores before and 24-48 hours after the ED intervention. 86 participants (mean 46 +/- 16.1 years; 58% female) were enrolled from July 2022 to April 2023, with 49 (57%) receiving the CBT-PT intervention. 55% of participants identified as Black and 13% as Hispanic; 15% reported no health insurance. On average, 1-2 participants were enrolled during each 8-hour enrollment day, indicating sufficient feasibility. Using a 1-5 Likert scale (5=highest satisfaction), CBT-PT participants reported a mean satisfaction score of 3.7 (SD 1.2) on average; indicating intervention acceptability. Preliminary effect sizes are shown in the Table. Conclusion: Delivering CBT-PT to patients in an ED setting was feasible, acceptable, and had promising preliminary effects on physical function and pain interference. CBT-PT should be explored as a novel treatment for improving neck and back pain outcomes in the ED, and our findings provide strong support for a future efficacy trial. No, authors do not have interests to disclose