Use of cognitive behavioural therapy with usual physical therapy intervention for individuals who are unemployed secondary to chronic low back pain: A case series

Abstract

Background Low back pain (LBP) is a leading cause of work absence and may influence the development of fear‐avoidance behaviours. The purpose of this case series was to examine the use of cognitive behavioural therapy (CBT) with physical therapy (PT) for the treatment of fear‐avoidance behaviours in patients with chronic LBP who are disabled or in a period of work absence. Case description Four patients with high‐irritability chronic LBP who were considered as being on work absence or disability were treated in outpatient PT clinics. The intervention consisted of fundamental CBT concepts utilized in combination with a traditional PT intervention. Outcomes Patients were treated until the achievement of functional goals and normalized movement patterns. Pain, disability and function were measured via a numerical pain rating scale, the Oswestry Disability Index and Focus on Therapeutic Outcomes. All patients achieved the minimally clinically important difference for these measures. Fear‐avoidance behaviours decreased, as observed by an average 15‐point change in Fear‐Avoidance Behaviour Questionnaire (Physical Activity) outcomes. Patients on work absence returned to work. Discussion This case series describes the use of CBT in combination with a traditional PT intervention for the treatment of high‐irritability, fear‐avoidant individuals who are on disability or in a period of work absence. The results indicated that CBT may be a useful and feasible adjunct to PT and may positively influence a return to work. Further studies are needed to determine effectiveness, including randomized controlled trials.