Dr. Celso Andrea [Azienda sanitaria Friuli Occidentale – AsFO, Distretto delle Dolomiti Friulane, Maniago (PN), Italy]
Dr.ssa Canderan Monica [Azienda sanitaria Friuli Occidentale – AsFO, Distretto delle Dolomiti Friulane, Maniago (PN), Italy]
Persistent Non-specific Low Back Pain (NsLBP) constitutes a major global challenge1-3 and a source of significant suffering, disability and healthcare costs4. In this case-series, we present the results of a combined physiotherapy treatment merging Mindfulness-based Therapy5 with Acceptance and Commitment Therapy (ACT)6-7. ACT has been shown to have positive effects in chronic pain8, and meta-analyses showed improvements in pain intensity, physical functioning, depression and anxiety, and quality of life (QoL)9.
n 50 with Non-specific Low Back Pain (NsLBP) patients (29 M, 21 F) was consecutively enrolled in one-year period and evaluated with initial, post-intervention (six months) evaluation and one-year follow-up, with administration of Patient-Related Outcome Measures (PROMs) such as Örebro Musculoskeletal Pain Screening Questionnaire (OMPSQ) and consequent further functional and psychosocial assessment with Roland Morris Disability Questionnaire (RMDQ), Fear Avoidance Beliefs Questionnaire (FABQ), Tampa Scale of Kinesiophobia (TSK), Pain Catastrophizing Scale (PCS), Coping Strategies Questionnaire (CSQ) and Pain Self-Efficacy Questionnaire (PSEQ), as measures to evaluate patients’ mindset change and treatment engagement. Physiotherapy treatment was based on Mindfulness sessions with body scan audio record and meditation walks merged with ACT principles to teach simple psychological skills, to promote psychological flexibility, and to address facilitators and barriers to self-management.
Under a dispositionalist patient-centred approach10-11, the therapeutic process was multidimensional in nature, encompassing biomedical, psychological, social, and experiential components, and enables the construction of an intersubjective12 space between the clinician and the patient, where the characteristics of both can find a space headed towards a narrative shared sense-making process13 and an appropriate engagement to foster the therapeutic alliance14-16. Psychologically informed practice17-19 guided the therapeutical journey, where Motivational Interviewing (MI)20 framework, Mindfulness and ACT principles enabled to improve psychological flexibility and enhance personal engagement and self-management activation, as shown at the end of therapeutic program (six month) and at one-year follow-up, at outcomes re-evaluation comparing to baseline.
A multidimensional patient-centred approach21 under a dispositionalist causal framework of reference, with the aim of whole person scrutiny22, may representing a good viaticum that prompt patients’ recovery and thrive. The recovery of functional levels and implementation of self-management programs23 consent to cope successfully with LBP complaint, under a shared clinical decision-making and personal empowerment lens. Further, be acquainted in Mindfulness and ACT’s core principles, directly reduces avoidance and promotes openness, bringing the possibility to build present-focused awareness, and coordinate greater engagement in goal-oriented and values-based activities.
