student profile: Mr John Petrozzi


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Thesis work

Thesis title: Management of Chronic Low Back Pain in Manual Therapy Practice

Supervisors: Martin MACKEY , Andrew LEAVER , Paulo FERREIRA , Mairwen JONES

Thesis abstract:

�p�Various interventions are available for the treatment of chronic low back pain (LBP), including Manual Therapy and Cognitive Behavioural Therapy (CBT).�/p� �p�OVERALL AIMS AND SUB-AIMS OF PHD PROJECT: The overall aim of this PhD thesis is to explore in depth the management of chronic low back pain in primary manual therapy care settings and particularly within the recommended biopsychosocial framework.�/p� �p�Specifically, the thesis aims to explore:�/p� �p�Study 1: The effects on low back related pain and disability of adding Internet-based cognitive behavioural therapy (MoodGYM) to standard care (multimodal manual therapy) compared to usual care alone. The purpose of this study is to evaluate whether the addition of an internet-based CBT program leads to better outcomes in patients who are treated with multimodal manual therapy for chronic LBP.�/p� �p�Methods/Design: A randomized controlled trial comparing a combined intervention, consisting of Internet-based CBT utilising MoodGYM plus multimodal manual therapy, to multimodal manual therapy alone for patients with chronic LBP. Multimodal manual therapy is delivered by experienced chiropractors and physiotherapists. Treatment sessions consist of a combination of joint and soft tissue mobilisation; spinal manipulation as well as muscle and fascia massage; education and reassurance; and rehabilitative exercise prescription.�/p� �p�In total, 108 adult participants were recruited from multiple chiropractic and physiotherapy private practices in Australia. Participants older than 18 years of age and diagnosed with chronic non-specific LBP were included in the trial, where chronic LBP is defined as continuous or fluctuating pain for a minimum of three months. The Keel StarT Back tool was used to screen for potential participants who are in the medium risk category. The primary outcomes are self-efficacy and disability measured by the Patient Self-Efficacy Questionnaire (PSEQ) and Roland Morris Disability Questionnaire (RMDQ) respectively. Secondary outcome measures assess pain, catastrophising, depression, anxiety, stress and workability.�/p� �p�Participants were randomly allocated into one of two groups. Both groups received an upper limit of 12 multimodal manual therapy sessions throughout 8 weeks. The intervention group also received five weeks of MoodGYM covering five modules in total. Assessment conducted at baseline, post-treatment 8- and follow-up at 26- and 52 weeks. Also, a verbal pain measure was completed by the treating practitioner at the time of treatments on an 11-point VAS.�/p� �p�The primary data analysis was by intention to treat using a linear mixed model for each outcome. This is a randomised controlled trial that investigates the potential benefits of adding a widely available and inexpensive internet-based psychological intervention to standard multimodal manual therapy for the management of chronic low back pain. This research trial is currently in under revision with an international peer-reviewed scientific journal. Study 2 To evaluate the experiences and opinions of participants’ involvement in the trial (Study 1) by carrying out semi-structured interviews within a qualitative process evaluation framework. The main aim of this process evaluation is to assess the participants’ thoughts on the perceived usefulness of an internet-delivered CBT, along with usual care in primary allied health practice for people with chronic LBP.�/p� �p�Aims: To evaluate the experiences and opinions of participants’ involvement in the trial. To carry out this evaluation, the researcher (MJP) intends to design and implement a qualitative process evaluation, by collecting feedback from participants in the Mind Your Back trial, using audio-recorded semi-structured interviews. The main aim of this process evaluation is to assess the participants’ thoughts on the perceived usefulness of an internet-delivered CBT, along with usual care in primary allied health practice for people with chronic LBP.�/p� �p�Methodology: This study will follow a qualitative process evaluation methodology. Research shows that process evaluation enables a better understanding of the implementation and reception of intervention within its context of the application, therefore aiding the interpretation of its outcome. Because the process evaluation aims to capture participants’ meanings and thoughts about the intervention, a broadly interpretivist approach will be taken to guide the qualitative study design and analytical framework. Interpretivism is based on the understanding of subjective experience and beliefs of the participants being studied. Within the context of the Mind Your Back trial, experiences and beliefs of participants in Group 1 and Group 2 in relation to usual care and CBT-aided care will be collected and assessed by the researcher.�/p� �p�Data analysis: A inductive thematic analysis will be conducted by two researchers (MJP and GS). A researcher with experience in qualitative methodology (GS) will act as a peer overseer, to ensure credibility and rigour in the analysis. The analysis and reporting of the data collected will follow the Consolidated Criteria for Reporting Qualitative research (COREQ) for reliable reporting and reproducibility of findings.�/p� �p�Study 3 Investigate the behavioural and psychological predictors of recovery or recurrence of low back pain through an in-depth literature review.�/p� �p�Study 4 Determine the behavioural and psychological predictors of recurrence of low back pain-related disability from the data gathered from study 1.�/p� �p�Title: Can pain and disability outcomes at 6- and 12-months be predicted by demographic, physical and psychosocial determinants early in the management of chronic NSLBP: a prospective cohort study.�/p� �p�Objective: Which demographic, physical and psychosocial determinants can predict pain and disability at 6 and 12 months on patients with CNSLBP? A secondary analysis of an RCT.�/p� �p�Methods: Multivariable regression analyses of data from a prospective cohort study will be used to ascertain whether demographic, physical and psychosocial determinants at baseline can be used to predict levels of pain and disability at 6- and 12-month follow-up periods after treatment.�/p� �p�The overall significance of this PhD.�/p� �p�The Results of this work can help manual therapy clinicians apply a biopsychosocial framework to a globally burdensome group.�/p�

Selected publications

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Journals

  • Petrozzi, M., Leaver, A., Jones, M., Ferreira, P., Rubinstein, S., Mackey, M. (2015). Does an online psychological intervention improve self-efficacy and disability in people also receiving Multimodal Manual Therapy for chronic low back pain compared to Multimodal Manual Therapy alone? Design of a randomized controlled trial. Chiropractic and Manual Therapies, 23(1), 1-8. [More Information]

2015

  • Petrozzi, M., Leaver, A., Jones, M., Ferreira, P., Rubinstein, S., Mackey, M. (2015). Does an online psychological intervention improve self-efficacy and disability in people also receiving Multimodal Manual Therapy for chronic low back pain compared to Multimodal Manual Therapy alone? Design of a randomized controlled trial. Chiropractic and Manual Therapies, 23(1), 1-8. [More Information]

Note: This profile is for a student at the University of Sydney. Views presented here are not necessarily those of the University.