The Effectiveness of Group-Based Physiotherapy-Led Behavioral Psychological Interventions on Adults With Chronic Low Back Pain

Abstract

Group-based physiotherapy-led behavioral psychological interventions (GPBPIs) are an emerging treatment for chronic low back pain, but the efficacy of these interventions is uncertain. A review of relevant randomized controlled trials and a meta-analysis was conducted to evaluate the effectiveness of GPBPIs on pain relief in adults with chronic low back pain. Literature databases, Google Scholar, bibliographies, and other relevant sources were searched. Thirteen intervention studies (13) published from 1998 to 2013 were included. The meta-analysis was conducted using RevMan software in accordance with the Cochrane Handbook for Systematic Reviews of Interventions. In reviewing the short- (<6 mos), intermediate- (≥6 and <12 mos), and longer-term (≥12 mos) effects of GPBPIs, long-term follow-up evaluations showed large and significant effect sizes (standardized mean difference = −0.25, 95% confidence interval = −0.39 to −0.11, I 2 = 38%, P < 0.01). Subgroup analysis indicated that patients from GPBPIs group had the greater short-, intermediate-, and long-term pain reduction than patients on waiting listing or usual care group. Compared with other active treatments, GPBPIs showed a small but significant long-term pain reduction in patients with chronic low back pain (standardized mean difference = −0.18, 95% confidence interval = −0.35 to −0.01, I 2 = 32%, P = 0.04). In general, GPBPIs may be an acceptable intervention to relieve pain intensity.

<p>Chronic Pain Patients’ Kinesiophobia and Catastrophizing are Associated with Activity Intensity at Different Times of the Day</p>

“…We recruited 40 participants from a waiting list for a multidisciplinary chronic pain program, which has occurred in other studies. 31,32 All participants suffered from idiopathic chronic pain, which is characterized as pain not related to any known disease or injury and pain that cannot better be explained by another chronic pain condition, experienced at least once a week during the last 3 months. 33 Participants were included in this study if they were on the waiting list for a chronic pain treatment program which includes being diagnosed with idiopathic chronic pain.…”

“…Previous studies have approached subjects on a wait list in order not to withhold treatment for research purposes. 31,32 However, most chronic pain subjects have interacted with multiple clinicians and are often seeking additional treatment options but their choice of seeking treatment may affect the results of this study. We did not conduct a power calculation a priori so these results must be interpreted with caution.…”

Best Evidence Rehabilitation for Chronic Pain Part 3: Low Back Pain

“…This might explain the difficulties currently encountered to identify the optimal exercise modality and dosage for CLBP management [24,57]. This statement is (partly) underscored by the evidence on treatment modalities that combine exercises with a psychological component (i.e., biopsychosocial approach) [20,23,32].…”

“…Three systematic reviews (two of which included a meta-analysis) focused on the effectiveness of a biopsychosocial treatment approach [20,23,32]. This approach involves a physical component combined with a psychological component and/or a social/work targeted component [32].…”

“…Results of this approach compared to other active treatments are promising. For example, while there was no difference at short- and intermediate-term follow-up, behavioral psychological interventions were more effective to reduce pain at short-term and long-term follow-up than active treatments without a psychological component [20,58,59]. Interestingly, the best results were found for multidisciplinary biopsychosocial rehabilitation [32].…”