Physiotherapy: The PACT Study

Updated 8 June 2016

PACT is a new type of physiotherapy based on a form of cognitive behavioural therapy called Acceptance and Commitment Therapy (ACT).  The PACT Study aims to combine psychological approaches with physiotherapy to offer patients better support with their persistent back pain. This novel treatment will be compared to usual physiotherapy care to see which is most successful at improving people’s ability to manage their back pain in the long term. The randomised controlled trial is being carried out by researchers at King’s College Departments of Psychology and Physiotherapy, working with physiotherapists and patients from Guy’s and St Thomas’ NHS Foundation Trust, King’s College Hospital NHS Foundation Trust and Ashford and St Peter’s Hospitals.  

ACT: A New Approach to Behaviour Change in Chronic Pain

Chronic low back pain (CLBP) is common, affecting 60% of the UK population. It is a major cause of personal suffering, disability and time off work, costing the NHS over £1 billion a year. 1.26 million patients seek physiotherapy for chronic low back pain each year, yet standard physiotherapy is only moderately effective at improving patient outcomes.

One promising approach to chronic pain is Acceptance and Commitment Therapy (ACT), a form of Cognitive Behavioural Therapy (CBT). The primary focus of ACT is on enhancing psychological flexibility and reducing struggle with pain. This involves helping people to accept their pain and related feelings, become more aware and less dominated by thoughts and beliefs about pain, and to identify and follow directions in life that reflect the things that are really important to them.

The team at King’s College London has developed a new type of physiotherapy informed by ACT, called PACT. The central focus of PACT is on improving functioning, not on reducing pain, by working towards patients’ value based goals. PACT comprises two one hour face-to-face sessions and a 20 minute booster telephone call with a specially trained physiotherapist.

The Clinical Trial

The PACT study is a randomised controlled trial involving 240 participants with chronic low back pain referred to the physiotherapy departments of Guy’s and St Thomas’, King’s College Hospital and Ashford and St Peter’s Hospitals. 120 participants will receive standard physiotherapy and 120 will receive PACT. At the end of the study a comparison will be made between changes in functioning (assessed by the Roland Morris Disability Questionnaire) and secondary outcomes (including pain, beliefs about pain, mood, quality of life and satisfaction with treatment) before and following completion of treatments at three months and 12 months. As of October 2015, 150 patients have been recruited. We aim to complete recruitment May 2016 and publicise the findings in 2017.

The protocol for the randomised controlled trial was published in BMJ Open on 7 June 2016.

To find out more about PACT, please contact Dr Vari Wileman.

Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 5th Floor, Bermondsey Wing, Guy's Hospital, London SE1 9RT.

Tel |07919 547 458 | 0207 188 5422 Email | vari.wileman@kcl.ac.uk