Clinical Scorecard: Development and Execution of an Online Acceptance and Commitment Therapy Program with Increased Therapist Involvement for Chronic Low Back Pain Management

At a Glance

Key Highlights

• ACT is an evidence-based psychological intervention effective for chronic pain, improving depression, anxiety, sleep, pain catastrophizing, and pain interference.
• The BEST Trial evaluated an online ACT program with enhanced therapist involvement as part of a precision medicine approach to cLBP treatment.
• Online ACT with therapist support aims to overcome barriers to multimodal care and improve patient engagement and treatment outcomes.

Guideline-Based Recommendations

Diagnosis

• Identify chronic low back pain as pain lasting at least three months with daily occurrence.
• Consider psychological and behavioral factors contributing to symptom maintenance.

Management

• Implement Acceptance and Commitment Therapy to increase psychological flexibility and promote values-based activity engagement.
• Deliver ACT via an online platform combining interactive multimedia sessions, scheduled therapist video visits, and ongoing messaging support.
• Integrate ACT as part of a multimodal treatment plan including exercise, manual therapy, pharmacotherapy, and self-management.

Monitoring & Follow-up

• Assess patient engagement with online sessions and therapist interactions.
• Monitor changes in pain-related depression, anxiety, sleep quality, pain catastrophizing, and functional interference.
• Evaluate psychological flexibility and adherence to values-based activities.

Risks

• Potential for incomplete engagement or dropout without therapist support; enhanced therapist involvement may mitigate this risk.
• No specific adverse effects of ACT reported; monitor for any worsening psychological distress.

Patient & Prescribing Data

Adults with chronic low back pain enrolled in the BEST Trial receiving online ACT intervention

Therapist-supported online ACT shows promise in improving treatment adherence and outcomes compared to self-guided approaches, with moderate effect sizes on pain and psychological outcomes.

Clinical Best Practices

• Use a multimodal approach combining ACT with physical and pharmacologic therapies tailored to patient phenotype and response.
• Enhance online ACT programs with therapist video sessions and messaging to maintain engagement and provide personalized support.
• Focus on increasing psychological flexibility through acceptance, mindfulness, and values-based behavioral activation.
• Incorporate patient input and stakeholder feedback in program design to address barriers to care.

References

• BEST Trial ClinicalTrials.gov Registration