Tags

Type your tag names separated by a space and hit enter

Active exercise, education, and cognitive behavioral therapy for persistent disabling low back pain: a randomized controlled trial.
Spine (Phila Pa 1976). 2007 Jul 01; 32(15):1578-85.S

Abstract

STUDY DESIGN

A randomized controlled trial.

OBJECTIVES

To determine 1) whether, among patients with persistent disabling low back pain (LBP), a group program of exercise and education using a cognitive behavioral therapy (CBT) approach, reduces pain and disability over a subsequent 12-month period; 2) the cost-effectiveness of the intervention; and 3) whether a priori preference for type of treatment influences outcome.

SUMMARY OF BACKGROUND DATA

There is evidence that both exercise and CBT delivered in specialist settings is effective in improving LBP. There is a lack of evidence on whether such interventions, delivered by trained individuals in primary care, result in improved outcomes.

METHODS

The study was conducted in nine family medical practices in East Cheshire, UK. Patients 18 to 65 years of age, consulting with LBP, were recruited; those still reporting LBP 3 months after the initial consultation were randomized between the two trial arms. The intervention arm received a program of eight 2-hour group exercise session over 6 weeks comprising active exercise and education delivered by physiotherapists using a CBT approach. Both arms received an educational booklet and audio-cassette. The primary outcome measures were pain (0-100 Visual Analogue Scale) and disability (Roland and Morris Disability Scale; score 0-24).

RESULTS

A total of 196 subjects (84%) completed follow-up 12 months after the completion of the intervention program. The intervention showed only a small and nonsignificant effect at reducing pain (-3.6 mm; 95% confidence interval, -8.5, 1.2 mm) and disability (-0.6 score; 95% confidence interval, -1.6, 0.4). The cost of the intervention was low with an incremental cost-effectiveness ratio of pound5000 (U.S. $8650) per quality adjusted life year. In addition, patients allocated to the intervention that had expressed a preference for it had clinically important reductions in pain and disability.

CONCLUSIONS

This intervention program produces only modest effects in reducing LBP and disability over a 1-year period. The observation that patient preference for treatment influences outcome warrants further investigation.

Authors+Show Affiliations

Division of Clinical Psychology, Medical School, University of Manchester, Manchester, UK.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17621203

Citation

Johnson, Ruth E., et al. "Active Exercise, Education, and Cognitive Behavioral Therapy for Persistent Disabling Low Back Pain: a Randomized Controlled Trial." Spine, vol. 32, no. 15, 2007, pp. 1578-85.
Johnson RE, Jones GT, Wiles NJ, et al. Active exercise, education, and cognitive behavioral therapy for persistent disabling low back pain: a randomized controlled trial. Spine (Phila Pa 1976). 2007;32(15):1578-85.
Johnson, R. E., Jones, G. T., Wiles, N. J., Chaddock, C., Potter, R. G., Roberts, C., Symmons, D. P., Watson, P. J., Torgerson, D. J., & Macfarlane, G. J. (2007). Active exercise, education, and cognitive behavioral therapy for persistent disabling low back pain: a randomized controlled trial. Spine, 32(15), 1578-85.
Johnson RE, et al. Active Exercise, Education, and Cognitive Behavioral Therapy for Persistent Disabling Low Back Pain: a Randomized Controlled Trial. Spine (Phila Pa 1976). 2007 Jul 1;32(15):1578-85. PubMed PMID: 17621203.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Active exercise, education, and cognitive behavioral therapy for persistent disabling low back pain: a randomized controlled trial. AU - Johnson,Ruth E, AU - Jones,Gareth T, AU - Wiles,Nicola J, AU - Chaddock,Carol, AU - Potter,Richard G, AU - Roberts,Chris, AU - Symmons,Deborah P M, AU - Watson,Paul J, AU - Torgerson,David J, AU - Macfarlane,Gary J, PY - 2007/7/11/pubmed PY - 2007/8/9/medline PY - 2007/7/11/entrez SP - 1578 EP - 85 JF - Spine JO - Spine (Phila Pa 1976) VL - 32 IS - 15 N2 - STUDY DESIGN: A randomized controlled trial. OBJECTIVES: To determine 1) whether, among patients with persistent disabling low back pain (LBP), a group program of exercise and education using a cognitive behavioral therapy (CBT) approach, reduces pain and disability over a subsequent 12-month period; 2) the cost-effectiveness of the intervention; and 3) whether a priori preference for type of treatment influences outcome. SUMMARY OF BACKGROUND DATA: There is evidence that both exercise and CBT delivered in specialist settings is effective in improving LBP. There is a lack of evidence on whether such interventions, delivered by trained individuals in primary care, result in improved outcomes. METHODS: The study was conducted in nine family medical practices in East Cheshire, UK. Patients 18 to 65 years of age, consulting with LBP, were recruited; those still reporting LBP 3 months after the initial consultation were randomized between the two trial arms. The intervention arm received a program of eight 2-hour group exercise session over 6 weeks comprising active exercise and education delivered by physiotherapists using a CBT approach. Both arms received an educational booklet and audio-cassette. The primary outcome measures were pain (0-100 Visual Analogue Scale) and disability (Roland and Morris Disability Scale; score 0-24). RESULTS: A total of 196 subjects (84%) completed follow-up 12 months after the completion of the intervention program. The intervention showed only a small and nonsignificant effect at reducing pain (-3.6 mm; 95% confidence interval, -8.5, 1.2 mm) and disability (-0.6 score; 95% confidence interval, -1.6, 0.4). The cost of the intervention was low with an incremental cost-effectiveness ratio of pound5000 (U.S. $8650) per quality adjusted life year. In addition, patients allocated to the intervention that had expressed a preference for it had clinically important reductions in pain and disability. CONCLUSIONS: This intervention program produces only modest effects in reducing LBP and disability over a 1-year period. The observation that patient preference for treatment influences outcome warrants further investigation. SN - 1528-1159 UR - https://www.unboundmedicine.com/medline/citation/17621203/Active_exercise_education_and_cognitive_behavioral_therapy_for_persistent_disabling_low_back_pain:_a_randomized_controlled_trial_ L2 - https://doi.org/10.1097/BRS.0b013e318074f890 DB - PRIME DP - Unbound Medicine ER -