Chronic Low Back Pain
Conditions
Keywords
Cognitive Functional Therapy, Manual Therapy and Exercise, Chronic Low Back Pain, Randomized Controlled Trial, Subclassification
Brief summary
A randomized controlled trial of the efficacy of classification based cognitive functional physiotherapy according to the system proposed by Peter O'Sullivan as compared to manual therapy and exercise in patients with non specific chronic low back pain. The investigators hypothesis was that treatment targeted at the mechanism behind the problem from a multidimensional perspective would be superior to traditional treatment.
Detailed description
NSCLBP is widely viewed as a multifactorial biopsychosocial pain syndrome. It has been proposed by several authors that NSCLBP represents a vicious cycle associated with different combinations of maladaptive; cognitive (negative beliefs, fear avoidance behaviours, catastrophising, depression, stress, lack of pacing and coping), physical (pain provocative postures, movement patterns and pain behaviours) and lifestyle (inactivity, rest) behaviours that act to promote pain and disability. However a recent systematic review suggests that this change in paradigm and our new understanding of NSCLBP has not resulted in clinical trials utilizing multidimensional classification systems or targeted interventions based on the underlying mechanisms. line with this shift in paradigm a novel multidimensional classification system has been developed incorporating the biopsychosocial model, which subgroups patients based on their presentation of. with matched interventions directed at the maladaptive cognitive, physical and lifestyle behaviours associated with the disorder.
Interventions
A novel multidimensional classification system has been developed incorporating the biopsychosocial model, which subgroups patients based on their presentation with matched interventions directed at the maladaptive cognitive, physical and lifestyle behaviours associated with the disorder. The intervention is called 'cognitive functional therapy' as it directly challenges these behaviours in a functionally specific and graduated manner.
Patients in this group was treated with joint mobilization or manipulation techniques applied to the spine or pelvis primarily and was designed to be consistent with best current manual therapy practice in Norway. The particular dose and techniques were at the discretion of the treating therapist, based on each participant's objective and physical examination findings. In addition most of the patients in this group was given exercises or a home exercise program.
Sponsors
Norwegian Fund for Postgraduate Training in Physiotherapy
University of Bergen
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
Yes
Inclusion criteria
* all patients with non-specific LBP for more that 8 weeks duration * mechanical provocation of pain with postures, movement and activities * localised pain in the area from T12 to gluteal folds * moderate ongoing LBP with a VAS \> 2/10 * disability had to be higher than 14% on Oswestry Disability Index
Exclusion criteria
* sick listed for more than 4 months continuous duration * acute exacerbation of LBP * radicular pain with positive neural tissue provocation test * any low limb surgery on the last 3 months * surgery involving the lumbar spine (fusion) * pregnancy * psychiatric disorders - somatisation * dominant psycho-social problems * widespread non-specific pain disorder (no primary LBP focus) * specific diagnoses: active rheumatologic disease, progressive neurological disease, serious cardiac or other internal medical condition, malignant basic diseases, acute traumas, infections, or acute vascular catastrophies
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Disability | 12 months | Disability measured by Oswestry Disability Index. |
| Pain | 12 months | Pain was assessed using a pain numerical rating scale from 0 to 10 |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Well being | 12 months | Hopkins Symptoms Checklist. |
| Beliefs | 12 months | Fear Avoidance Beliefs Questionnaire |
| Screening questionnaire | 12 months | The Ørebro Pain Screening Questionnaire |
| Patient satisfaction | 12 months | patient satisfaction. 5 items scale |
Countries
Norway
Outcome results
None listed