Group cognitive behavioural treatment for low-back pain in primary care: a randomised controlled trial and cost-effectiveness analysis

Lamb, Sarah E; Hansen, Zara; Lall, Ranjit; Castelnuovo, Emanuela; Withers, Emma; Nichols, Vivien; Potter, Rachel; Underwood, Martin

doi:10.1016/s0140-6736(09)62164-4

Cited by 361 publications

(332 citation statements)

References 26 publications

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“…The only exceptions were two studies which recruited participants of a mixed duration of symptoms [30,32] two which did not specify the duration of symptoms [20], and one which recruited participants sick listed for less than 2 weeks due to LBP [31]. Most studies were conducted in the UK [32][33][34][35][36][37][38][39][40] or other European countries [21-24, 26-29, 31, 41-45]; three studies were conducted in the United States [20,30] and two in Canada [25,46]. All studies were published in English.…”

Section: Characteristics Of Included Trialsmentioning

confidence: 99%

“…Six studies compared advice to another treatment [20-22, 27, 38, 46], and three compared adding another treatment to advice with advice alone [23,24,26,36]. Regardless of the comparison and the economic perspective adopted, results regarding the cost-effectiveness of advice were inconsistent across the studies (Table 2).…”

Section: Quality Of the Economic Evaluationmentioning

confidence: 99%

“…These interventions were compared to conventional physiotherapy [29,32,33,43], GP care [25,28,30,35], spinal surgery [29] or walking [39], or as an additional treatment to advice [23,24,26], GP care [34,36,40] or inpatient rehabilitation [44]. Regardless of the comparisons and the perspectives adopted, all but two studies [30,32] found that these interventions were cost-effective compared to the treatment alternatives (Table 3).…”

Section: Quality Of the Economic Evaluationmentioning

confidence: 99%

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Cost-effectiveness of guideline-endorsed treatments for low back pain: a systematic review

Lin

Haas

Maher

et al. 2011

Deutsche Zeitschrift für Akupunktur

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Healthcare costs for low back pain (LBP) are increasing rapidly. Hence, it is important to provide treatments that are effective and cost-effective. The purpose of this systematic review was to investigate the cost-effectiveness of guideline-endorsed treatments for LBP. We searched nine clinical and economic electronic databases and the reference list of relevant systematic reviews and included studies for eligible studies. Economic evaluations conducted alongside randomised controlled trials investigating treatments for LBP endorsed by the guideline of the American College of Physicians and the American Pain Society were included. Two independent reviewers screened search results and extracted data. Data extracted included the type and perspective of the economic evaluation, the treatment comparators, and the relative costeffectiveness of the treatment comparators. Twenty-six studies were included. Most studies found that interdisciplinary rehabilitation, exercise, acupuncture, spinal manipulation or cognitive-behavioural therapy were costeffective in people with sub-acute or chronic LBP. Massage alone was unlikely to be cost-effective. There were inconsistent results on the cost-effectiveness of advice, insufficient evidence on spinal manipulation for people with acute LBP, and no evidence on the cost-effectiveness of medications, yoga or relaxation. This review found evidence supporting the cost-effectiveness of the guidelineendorsed treatments of interdisciplinary rehabilitation, exercise, acupuncture, spinal manipulation and cognitivebehavioural therapy for sub-acute or chronic LBP. There is little or inconsistent evidence for other treatments endorsed in the guideline.

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Section: Characteristics Of Included Trialsmentioning

confidence: 99%

Section: Quality Of the Economic Evaluationmentioning

confidence: 99%

Section: Quality Of the Economic Evaluationmentioning

confidence: 99%

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Cost-effectiveness of guideline-endorsed treatments for low back pain: a systematic review

Lin

Haas

Maher

et al. 2011

Deutsche Zeitschrift für Akupunktur

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“…Treatment packages of acupuncture needling, exercise, and manual therapy are recommended for the early management of persistent back pain by the National Institute of Health and Clinical Excellence guidelines (1). We have added to these data by demonstrating that a group cognitive-behavioral approach delivered by a range of health professionals has sustained the effect on low back pain disability, at a very modest cost to the health care provider (Back Skills Training Trial n ϭ 701) (2). Most of these interventions produce small to moderate mean benefits that are likely to be important at a population level, but that may not be important to an individual patient.…”

Section: Introductionmentioning

confidence: 99%

Predicting response to a cognitive–behavioral approach to treating low back pain: Secondary analysis of the BeST data set

Underwood¹,

Mistry²,

Lall³

et al. 2011

Arthritis Care & Research

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Objective. Identifying factors that predict who is likely to gain the greatest benefit from different treatments for low back pain is an important research priority. Here we report moderator analyses of the Back Skills Training Trial (BeST) that tested a cognitive-behavioral approach for low back pain. Methods. We recruited 701 participants ages >18 years with at least moderately troublesome low back pain present for >6 weeks from 56 general practices in 7 localities across England to a trial adding a group cognitive-behavioral approach to active management advice. The cognitive-behavioral package had a moderate effect on primary outcomes (Roland Morris Disability Questionnaire [RMDQ] and modified Von Korff scales). At 12-month followup, we tested for interaction between randomized groups on 2 prespecified baseline variables (troublesomeness and fear avoidance) and 10 post hoc (exploratory) variables identified from previous studies. Results. Neither troublesomeness nor fear avoidance moderated treatment effect on any of our primary outcomes. In the final model, the only moderation by baseline variables of the effect of randomization was on the RMDQ outcome. Being younger and currently working both moderated treatment effect, resulting in larger improvements as a response to treatment. Conclusion. Although BeST is one of the larger trials of back pain treatment, it is still too small to reliably detect moderation if it exists. Since the significant moderation effects were only observed for 1 outcome measure in 3 of 10 post-hoc analyses, we cannot conclude that these are true moderation effects.

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“…20 negative mood and catastrophising and feared avoidance beliefs, might all contribute to the pain experience. The individual's interpretation, evaluation and beliefs about his or her health condition affect the degree of emotional and physical disability that is associated with the pain.…”

Section: The Biopsychosocial Modelmentioning

confidence: 99%

The management of acute low back pain in adults: a guide for the primary care physician, Part II

Brighton

2013

South African Family Practice

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When a patient presents with acute low back pain (LBP), any red flag warnings of serious disease should first be excluded. Yellow and blue flag warnings of psychological factors should be noted. A psychological opinion of patients with substantial psychological distress could be sought. Advice may be offered on the benign nature of non-specific LBP. The person should be encouraged to be physically active and to continue with normal activities as far as possible. A structured exercise programme, that includes aerobic activity, movement instruction, muscle strengthening, postural control and stretching, should be devised. A combined exercise and psychological treatment programme that includes a cognitive behavioural approach can be considered in patients with significant disability or substantial psychological distress. A course of acupuncture may also be added. Manual therapy, including spinal manipulation, could be considered. Paracetamol should be the first medication option. If this is inadequate, a nonsteroidal anti-inflammatory drug or weak opioid, or both, can be added. Individual risks for side-effects and the patient's preference should be taken into account. Strong opioids should be considered in patients in severe pain, but for short-term use only. Antidepressants and gabapentine or pregabolin can be considered when there is a neurogenic component of the pain. Consider obtaining a surgical opinion on patients who have completed an optimal package of care and who still have persistent severe non-specific LBP. Progressive neurological fallout requires a surgical opinion.Peer reviewed.

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Group cognitive behavioural treatment for low-back pain in primary care: a randomised controlled trial and cost-effectiveness analysis

Cited by 361 publications

References 26 publications

Cost-effectiveness of guideline-endorsed treatments for low back pain: a systematic review

Cost-effectiveness of guideline-endorsed treatments for low back pain: a systematic review

Predicting response to a cognitive–behavioral approach to treating low back pain: Secondary analysis of the BeST data set

The management of acute low back pain in adults: a guide for the primary care physician, Part II

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