Physicians often treat non-specific chronic low back pain based on
three different models regarding the development and maintenance of
pain and especially functional limitations: the deconditioning model,
the cognitive behavioral model, and the biopsychosocial model. There
is evidence that rehabilitation is more effective than no treatment,
but little information about the differential effectiveness of different
kinds of rehabilitation. Two hundred and twenty-three patients attended
therapy three times a week for 10 weeks: Active Physical Treatment (APT),
Cognitive-Behavioral Treatment (CBT), Combined Treatment of APT and
CBT (CT), or Waiting List (WL). Data from 212 patients were analyzed.
Patient reported their functional limitations, main complaints, pain,
mood, rated treatment effectiveness, satisfaction with treatment, and
their physical performance--including walking, standing up, reaching
forward, stair climbing and lifting.
After treatment, there were significant reductions in functional limitations,
patient complaints, and pain intensity for all three active treatments
compared to the waiting list patients [no treatment]. Also, the self-rated
treatment effectiveness and satisfaction seemed higher in the three
active treatments. Several physical performance tasks improved in physical
therapy [APT] and combining physical therapy with cognitive-behavioral
therapy [CT] but not in cognitive-behavioral therapy alone [CBT]. No
relevant differences were found between combined therapy and physical
therapy, or between combined therapy and cognitive-behavioral therapy.
The researchers conclude that all three active treatments were effective
for non-specific chronic low back pain compared to no treatment at all,
but no clinically relevant differences exist between combined therapy
and the single component treatments. Smeets RJ, Vlaeyen JW, Hidding
A, Kester AD, van der Heijden GJ, van Geel AC, Knottnerus JA. Adapted from BMC Musculoskelet Disord. 2006 Jan 20;7(1):5.
PMID 16426449
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed
Credit: PubMed, developed by the National Center for Biotechnology Information
(NCBI) at the National
Library of Medicine (NLM).
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