Use of Intervention Mapping to Adapt a Psychologically Informed Physical Therapy Telerehabilitation Intervention for Latino Persons With Chronic Spine Pain

Abstract

The need for culturally tailored pain care is well-recognized, yet few studies report how existing interventions can be adapted to the needs of culturally and linguistically diverse populations. This report describes a formative mixed-methods approach using intervention mapping-adapt and the expanded framework for reporting adaptations and modifications to evidence-based interventions to adapt and report modifications of an existing physical therapy intervention for Latino persons with chronic spine pain in Federally Qualified Health clinics in the southwestern United States. Mixed methods included literature reviews, patient surveys, an Adaptation Advisory Panel, and sequential case series with semistructured interviews. Six steps of intervention mapping-adapt guided the adaptation process and adaptations were prospectively documented with framework for reporting adaptations and modifications to evidence-based interventions. A needs assessment revealed an absence of culturally tailored physical therapy interventions for Latino persons with chronic spine pain in the United States. An intervention logic model and review of the sociocultural context guided the selection of essential interventions, determinants of behavior change, and outcomes. An existing cognitive behavioral-based physical therapy telerehabilitation intervention was selected for adaptation based on accessibility and strong congruency with the logic model. An Adaptation Advisory Panel planned and evaluated iterative adaptations of the cognitive behavioral-based physical therapy intervention content, activities, delivery, materials, and design. The adapted Goal-Oriented Activity for Latino persons with Spine pain intervention aimed to reduce pain intensity and disability through patient-centered goal setting in physical and cognitive treatment domains. Sequential case series supported feasibility and acceptability of the adapted intervention in the target population. PERSPECTIVE: We describe adaptation and reporting of an evidence-based physical therapy intervention for a culturally and linguistically diverse population. Greater rigor and transparency using tools such as intervention mapping-adapt and framework for reporting adaptations and modifications to evidence-based interventions will accelerate efforts to reduce ethnic and racial disparities in pain rehabilitation.

Keywords: Ethnicity, minority health, telemedicine, chronic pain, biopsychosocial.