Cognitive-Behavioral-Based Physical Therapy for Improving Recovery After Traumatic Orthopaedic Lower Extremity Injury (CBPT-Trauma).

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Journal of Orthopaedic Trauma


Summary: Physical and psychological impairment resulting from traumatic injuries is often significant and affects employment and functional independence. Extremity trauma has been shown to negatively affect long-term self-reported physical function, the ability to work, and participation in recreational activities and contributes to increased rates of anxiety and/or depression. High pain levels early in the recovery process and psychosocial factors play a prominent role in recovery after traumatic lower extremity injury. Cognitive-behavioral therapy pain programs have been shown to mitigate these effects. However, patient access issues related to financial and transportation constraints and the competing demands of treatment focused on the physical sequelae of traumatic injury limit patient participation in this treatment modality. This article describes a telephone-delivered cognitive-behavioral-based physical therapy (CBPT-Trauma) program and design of a multicenter trial to determine its effectiveness after lower extremity trauma. Three hundred twenty-five patients from 7 Level 1 trauma centers were randomized to CBPT-Trauma or an education program after hospital discharge. The primary hypothesis is that compared with patients who receive an education program, patients who receive the CBPT-Trauma program will have improved physical function, pain, and physical and mental health at 12 months after hospital discharge.

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METRC Corporate Authors: Brooke Army Medical Center: Patrick M. Osborn, MD, Joseph E. Kimmel, MS, Dennis W. Mann, BSN, and Alycia N. Ramirez, BS; Carolinas Medical Center, Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute: Michael J. Bosse, MD, Joseph R. Hsu, MD, Laurence B. Kempton, MD, Kevin D. Phelps, MD, Rachel B. Seymour, PhD, Stephen H. Sims, MD, Claire Bartel, BS, Christine Churchill, MA, and Juliette Sweeney, BS; Johns Hopkins Bloomberg School of Public Health: Jiafeng Zhu, MS; McGovern Medical School at the University of Texas Health Science Center at Houston: Joshua L. Gary, MD (now at Keck School of Medicine of the University of Southern California), Andrew Choo, MD, Mayank Rao, MD, MBA, Stephen J. Warner, MD, PhD, Ryan J. Warth, MD, and Sterling J. Boutte, BS; R Adams Cowley Shock Trauma Center at the University of Maryland: Robert V. O'Toole, MD, Haley K. Demyanovich, MS, Katherine Joseph, MPH, Heather Phipps, MPS, and Joshua Rudnicki, BS; Vanderbilt University Medical Center: Daniel J. Stinner, MD, PhD, Brittany B. Myczkowski, DPT, PT (now at Marshfield Medical Center), and Akshita Patel, MS (now at Lincoln Memorial University); and METRC Coordinating Center at the Johns Hopkins Bloomberg School of Public Health: Lauren Allen, DrPH, and Anthony R. Carlini, MS.