Does group-based cognitive therapy improve functional ability, pain, catastrophic thoughts and quality of life in patients with persistent low back pain and psychological risk factors? A randomised controlled trial in a secondary care setting

Abstract

Objective To investigate the effects of a group-based cognitive behavioural intervention for patients with persistent low back pain (LBP) and psychological risk factors referred to secondary care. Design A randomised controlled trial. Setting Silkeborg Regional Hospital, Denmark. Subjects A total of 136 participants with chronic LBP and psychological risk factors. Interventions Participants were randomised to the standard care group, including examination by a rheumatologist and/or a physiotherapist, or the intervention group, including standard care plus a multidisciplinary group-based pain management programme. Main measures Patient-reported outcomes were collected at baseline and after 6 and 12 months. The primary outcome was disability (Roland Morris Disability Questionnaire). Secondary outcomes included low back pain intensity, pain catastrophising, health-related quality of life, and sick leave. Results Among 136 participants, 68 (mean age: 41.7 years (SD 11.8)) were randomised to standard care and 68 (mean age: 46.0 years (SD 10.8)) were randomised to the intervention group. Except for age, baseline characteristics were comparable between groups. 12-month follow-up was completed by 92.6% in the intervention group and 80.9% in the standard care group. Both groups achieved significant improvements on disability, with a reduction of −4.8 points (SD 6.1) in the intervention group compared to −3.7 points (SD 5.2), resulting in an insignificant difference between groups. No significant differences were found in the secondary outcomes. Conclusion A group-based pain management programme was no more effective than standard care for patients with persistent LBP and psychological risk factors.

"The Effectiveness of Cognitive Behavioral Therapy in Chronic Low Back Pain"

“…Αlthough there were no differences between groups, participants in the ACT who completed treatment reported better levels of satisfaction than participants in CBT in terms of it's about chronic pain. Nanna Rolving et al [28] investigated the effects of a group-based CBT intervention for patients with persistent LBP and psychological risk factors referred to secondary care. A total of 136 participants with chronic LBP and psychological risk factors.…”

“…Then of interest are the conflicting opinions of researchers Julie Loebach Wetherell [27] and Mary O'Keeffe [29] where the first researcher's group observes that CBT reduces chronic pain without particularly statistical data, while Mary O'Keeffe, et al [29] argue that with group exercise and education intervention CBT reduced disability but not pain. On the other hand, Nanna Rolving, et al [28] concluded that a group pain management program was just as effective as individual approach and patient care.…”