Efficiency of Associating Therapeutic Patient Education with Rehabilitation in the Management of Chronic Low Back Pain: A Randomized Controlled Trial

Abstract

Background: This study aimed to assess the benefits of associating rehabilitation with therapeutic patient education (TPE) to decrease fear-avoidance belief and pain and improve function in adults with chronic low back pain (CLBP).Methods: This randomized controlled study included 100 patients with CLBP according to the CONSORT (Consolidated Standards of Reporting Trials) guidelines. The patients were divided into two teams: group A that participated in the TPE in association with rehabilitation and group B that received rehabilitation only. Pain and functional amelioration were assessed initially (T0) and at the end of the program (T1) using a visual analog scale at rest, work, and activity, and the Echelle d’Incapacité Fonctionnelle pour l’Évaluation des Lombalgies scale. Psychological and apprehension and avoidance assessments were also conducted, including the evaluation of depression, anxiety, fear-avoidance belief, and kinesiophobia using the Hospital Anxiety and Depression Scale, Fear-Avoidance Beliefs Questionnaire, and Tampa scale of kinesiophobia scale.Results: The evaluation of progression initially (T0) and then at the end of the program (T1) revealed a significant reduction in pain at rest (P=0.00) and while working (P=0.00) and doing physical activity (P=0.03); a decrease in anxiety (P=0.03), fear-avoidance belief (P=0.03), and kinesiophobia (P=0.02); and an improvement in function (P=0.00) for patients in group A without amelioration of depression (P=0.15). Concerning group B, we identified a significant regression in pain at rest (P=0.001) and while working (P=0.03) and doing physical activity (P=0.00); depression (P=0.01); fear-avoidance beliefs (P=0.00); and kinesiophobia (P=0.002). Comparison between the groups revealed that associating TPE with rehabilitation resulted in a more significant improvement in function (P=0.00), anxiety (P=0.00), fear-avoidance belief (P=0.00), and kinesiophobia (P=0.00).Conclusion: Associating TPE with rehabilitation improved function and reduced fear, false beliefs, and kinesiophobia of movement in patients with CLBP.

Comparative effectiveness of non-pharmacological interventions in reducing psychological symptoms among patients with chronic low back pain

“…Among the included RCTs, 10 (15.2%) studies 42 , 43 , 47 , 49 , 54 , 57 , 67 , 81 , 88 , 98 had a low overall risk of bias, 37 (56.1%) 33 , 35 , 36 , 38 – 40 , 44 , 45 , 48 , 50 – 52 , 59 – 61 , 63 – 66 , 68 – 71 , 73 , 75 – 78 , 84 – 87 , 91 – 94 , 97 exhibited some concerns, and 19 (28.7%) 34 , 37 , 41 , 46 , 53 , 55 , 56 , 58 , 62 , 72 , 74 , 79 , 80 , 82 , 83 , 89 , 90 , 95 , 96 had a high overall risk of bias. The majority of RCTs presented low risks of missing outcome data (72.7%) and randomization (75.8%).…”

“…In the NMA involving 24 RCTs 34 – 38 , 43 , 45 , 49 , 51 , 52 , 54 , 59 , 68 – 70 , 72 , 75 – 79 , 84 , 88 , 97 , 1722 participants, and 7 categories of interventions with six loops (Fig. 4 ), mind body therapy (pooled SMD = −1.35, 95% CI: −1.90 to −0.80), multicomponent intervention (pooled SMD = −0.47, 95% CI: −0.88 to −0.06), and biopsychosocial approach (pooled SMD = −0.46, 95% CI: −0.79 to −0.14) were superior to the control group in managing anxiety.…”

Pain Education and Virtual Reality Improves Pain, Pain-related Fear of Movement, and Trunk Kinematics in Individuals with Persistent Low Back Pain

“…Previous studies have demonstrated greater reductions in TSK scores compared with other interventions when exercise or graded exposure is combined with a cognitivebehavioral approach 47 or pain education intervention. 48 However, other studies evaluating education or exercise alone compared with a combined approach have found no differences in pain-related fear of movement. 49,50 In these studies, no specific efforts were made to consolidate links between PSE and the pain experience during exercise, potentially highlighting the need for reflective learning as a core component of an exposure therapy approach.…”

“…We sought to integrate education principles with VR gameplay by providing constructive reinforcement of helpful cognitions through reflective interviewing and highlighting positive movement through video feedback. Previous studies have demonstrated greater reductions in TSK scores compared with other interventions when exercise or graded exposure is combined with a cognitive-behavioral approach 47 or pain education intervention 48 . However, other studies evaluating education or exercise alone compared with a combined approach have found no differences in pain-related fear of movement 49,50 .…”