Combined Physical and Psychological Programmes (CPPP): Survey of current practice and provision in the UK

The aim of this survey is to better understand current provision of Combined Physical and Psychological Programmes for people with low back pain within the UK- where programmes are and are not running!

Therefore we need to hear from you:

  •  - If you don’t have a CPPP and can't refer to a programme in your area
  •  - If you do have access to a programme
  •  - If you are a programme provider, we want to learn more about your programme.

Background

The National Low Back and Radicular Pain Pathway (NLBRPP) sets out current evidence based guidance for managing back and radicular pain in adults. One key component of this pathway is the provision of a Combined Physical and Psychological Programme (CPPP) (Figure 1, box 12).

Figure 1: National Low Back and Radicular Pain Pathway

A CPPP is a program (preferably in a group context) incorporating a psychological/ behavioural approach (such as Cognitive Behaviour Therapy or Acceptance and Commitment Therapy) alongside a physical (exercise) component to support participants explore unhelpful beliefs and behaviours which are barriers to recovery. There is significant variation in many aspects of CPPPs e.g. provision, content, intensity, frequency. A range of different terms are used to describe such programmes (e.g. MBR, FRP, CPPP, M-CPPP. Although existing evidence does not provide clear programme guidance, there is support for CPPP provision.

References:

1. National Guideline Centre (UK) Low Back Pain and Sciatica in Over 16s: Assessment and Management. London: National Institute for Health and Care Excellence (UK); 2016 Nov PMID: 27929617 (Link)

2. National low back and radicular pain pathway; (2017) trauma programme of care: NHS England (Link)


A CPPP by definition would contain the elements below:

  • Psychological/behavioural component- e.g. Acceptance and Commitment Therapy (ACT), Cognitive Behavioural Therapy (CBT)
  • Multidisciplinary (Can be uni-disciplinary if incorporates the above psychological and exercise components)
  • Preferably group context
  • Individualised physical exercise component
  • Extends over a period of weeks
A distinction is made between CPPPs and Pain Management Programmes (PMPs).  PMPs cater for those with more complex or widespread/multisite pain related disability with greater psychological component to the presentation.

Understanding current practice will inform clinicians and service decision makers (e.g. commissioners and managers) to guide future improvements in current provision to achieve best clinical outcomes for the patients we treat.

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