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The Effectiveness of Cognitive Behavioural Treatment for Non-Specific Low Back Pain: A Systematic Review and Meta-Analysis.

Richmond H, Hall AM, Copsey B, Hansen Z, Williamson E, Hoxey-Thomas N, Cooper Z, Lamb SE - PLoS ONE (2015)

Bottom Line: Of these, the majority studied patients with persistent LBP (>6 weeks; n=20).At long term follow-up, the pooled SMD for the WL/UC comparison was -0.19 (-0.38, 0.01) for disability, and -0.23 (-0.43, -0.04) for pain, in favour of CB.For the GAT comparison, at long term the pooled SMD was -0.83 (-1.46, -0.19) for disability and -0.48 (-0.93, -0.04) for pain, in favour of CB.

View Article: PubMed Central - PubMed

Affiliation: Centre for Rehabilitation Research, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, England, United Kingdom.

ABSTRACT

Objectives: To assess whether cognitive behavioural (CB) approaches improve disability, pain, quality of life and/or work disability for patients with low back pain (LBP) of any duration and of any age.

Methods: Nine databases were searched for randomised controlled trials (RCTs) from inception to November 2014. Two independent reviewers rated trial quality and extracted trial data. Standardised mean differences (SMD) and 95% confidence intervals were calculated for individual trials. Pooled effect sizes were calculated using a random-effects model for two contrasts: CB versus no treatment (including wait-list and usual care (WL/UC)), and CB versus other guideline-based active treatment (GAT).

Results: The review included 23 studies with a total of 3359 participants. Of these, the majority studied patients with persistent LBP (>6 weeks; n=20). At long term follow-up, the pooled SMD for the WL/UC comparison was -0.19 (-0.38, 0.01) for disability, and -0.23 (-0.43, -0.04) for pain, in favour of CB. For the GAT comparison, at long term the pooled SMD was -0.83 (-1.46, -0.19) for disability and -0.48 (-0.93, -0.04) for pain, in favour of CB. While trials varied considerably in methodological quality, and in intervention factors such as provider, mode of delivery, dose, duration, and pragmatism, there were several examples of lower intensity, low cost interventions that were effective.

Conclusion: CB interventions yield long-term improvements in pain, disability and quality of life in comparison to no treatment and other guideline-based active treatments for patients with LBP of any duration and of any age.

Systematic review registration: PROSPERO protocol registration number: CRD42014010536.

No MeSH data available.


Related in: MedlinePlus

Summary of conservative treatment recommendations in the European LBP guidelines.
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pone.0134192.g001: Summary of conservative treatment recommendations in the European LBP guidelines.

Mentions: From the identified studies, original studies were included if they were a randomised controlled trial, included patients with non-specific low back pain of any duration, contained a cognitive behavioural intervention arm, contained a comparison arm of wait-list control/usual care (WL/UC), and/or guideline-based active treatment (GAT), and included one of the following outcomes: pain, disability, quality of life, or work disability. The European LBP guidelines for acute [23] and chronic [24] non-specific LBP were used to guide the identification of treatments for the GAT comparison (Fig 1). Full descriptions of the inclusion and exclusion criteria, including our intervention definition, are reported in Table 1.


The Effectiveness of Cognitive Behavioural Treatment for Non-Specific Low Back Pain: A Systematic Review and Meta-Analysis.

Richmond H, Hall AM, Copsey B, Hansen Z, Williamson E, Hoxey-Thomas N, Cooper Z, Lamb SE - PLoS ONE (2015)

Summary of conservative treatment recommendations in the European LBP guidelines.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4526658&req=5

pone.0134192.g001: Summary of conservative treatment recommendations in the European LBP guidelines.
Mentions: From the identified studies, original studies were included if they were a randomised controlled trial, included patients with non-specific low back pain of any duration, contained a cognitive behavioural intervention arm, contained a comparison arm of wait-list control/usual care (WL/UC), and/or guideline-based active treatment (GAT), and included one of the following outcomes: pain, disability, quality of life, or work disability. The European LBP guidelines for acute [23] and chronic [24] non-specific LBP were used to guide the identification of treatments for the GAT comparison (Fig 1). Full descriptions of the inclusion and exclusion criteria, including our intervention definition, are reported in Table 1.

Bottom Line: Of these, the majority studied patients with persistent LBP (>6 weeks; n=20).At long term follow-up, the pooled SMD for the WL/UC comparison was -0.19 (-0.38, 0.01) for disability, and -0.23 (-0.43, -0.04) for pain, in favour of CB.For the GAT comparison, at long term the pooled SMD was -0.83 (-1.46, -0.19) for disability and -0.48 (-0.93, -0.04) for pain, in favour of CB.

View Article: PubMed Central - PubMed

Affiliation: Centre for Rehabilitation Research, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, England, United Kingdom.

ABSTRACT

Objectives: To assess whether cognitive behavioural (CB) approaches improve disability, pain, quality of life and/or work disability for patients with low back pain (LBP) of any duration and of any age.

Methods: Nine databases were searched for randomised controlled trials (RCTs) from inception to November 2014. Two independent reviewers rated trial quality and extracted trial data. Standardised mean differences (SMD) and 95% confidence intervals were calculated for individual trials. Pooled effect sizes were calculated using a random-effects model for two contrasts: CB versus no treatment (including wait-list and usual care (WL/UC)), and CB versus other guideline-based active treatment (GAT).

Results: The review included 23 studies with a total of 3359 participants. Of these, the majority studied patients with persistent LBP (>6 weeks; n=20). At long term follow-up, the pooled SMD for the WL/UC comparison was -0.19 (-0.38, 0.01) for disability, and -0.23 (-0.43, -0.04) for pain, in favour of CB. For the GAT comparison, at long term the pooled SMD was -0.83 (-1.46, -0.19) for disability and -0.48 (-0.93, -0.04) for pain, in favour of CB. While trials varied considerably in methodological quality, and in intervention factors such as provider, mode of delivery, dose, duration, and pragmatism, there were several examples of lower intensity, low cost interventions that were effective.

Conclusion: CB interventions yield long-term improvements in pain, disability and quality of life in comparison to no treatment and other guideline-based active treatments for patients with LBP of any duration and of any age.

Systematic review registration: PROSPERO protocol registration number: CRD42014010536.

No MeSH data available.


Related in: MedlinePlus