File
O'Keeffe M1,2,3, O'Sullivan P4,5, Purtill H6, Bargary N6, O'Sullivan K3,7
1University of Sydney, School of Public Health, Sydney, Australia, 2Institute for Musculoskeletal Health, Sydney, Australia, 3University of Limerick, School of Allied Health, Limerick, Ireland, 4Curtin University, Health Sciences Division, School of Physiotherapy and Exercise Science, Perth, Australia, 5Bodylogic Physiotherapy, Perth, Australia, 6University of Limerick, Department of Mathematics & Statistics, Limerick, Ireland, 7Aspetar Orthopaedic and Sports Medicine Hospital, Sports Spine Centre, Doha, Qatar
Background: Non-specific chronic low back pain (NSCLBP) is a costly disorder associated with a complex interplay of biopsychosocial factors. Cognitive functional therapy (CFT) is a patient-centred intervention which directly challenges pain-related behaviours in a cognitively integrated, functionally specific and graduated manner. One clinical trial demonstrated the superiority of individualised CFT for NSCLBP compared to manual therapy and exercise. However, several trials have shown that group interventions are as effective as one-to-one interventions for musculoskeletal pain conditions. Therefore, it is important to examine whether an individualised intervention, such as CFT, demonstrates clinical effectiveness compared to an exercise and education class.
Purpose: To compare a individualised multidimensional intervention (CFT), to group-based exercise and education classes on pain and disability in individuals with NSCLBP.
Methods: Design: A multicentre single blinded randomised controlled trial.
Setting: Two primary care centres and one public hospital in Ireland.
Participants: Individuals aged 18-75 years, with NSCLBP for more than six months, scoring at least 14% on the Oswestry Disability Index (ODI).
Interventions: A physiotherapy-led individualised multidimensional intervention (n=106) where length of intervention varied in a pragmatic manner based on the clinical progression of participants, and six exercise and education classes over a period of six to eight weeks (n=100).
Main outcomes and analysis: Primary outcomes were functional disability (ODI (0=no disability, 100=worst disability) and pain intensity in the past week (0= no pain, 10= worst pain) at post intervention, six months post-randomisation, and 12 months post randomisation. Analysis was by intention to treat, and treatment effects were calculated with linear mixed models.
Results: Of 206 randomised participants (including 152 women; mean age 48.7 years (standard deviation 14.1 years), 130 (63%) completed post-intervention follow-up, 148 (72%) completed six month follow-up, and 142 (69%) completed the 12 month follow-up.
At post-intervention, the mean disability score was 17.33 in the individualised intervention and 25.73 in the class (mean difference, 8.04; 95% confidence interval [CI] 4.43 to 12.73; p 0.001). At six months, the mean disability score was 19.98 in the individualised intervention and 28.65 in the group intervention (mean difference, 8.7; 95% CI 3.76 to 13.59; p=0.001). At 12 months, the mean disability score was 21.37 in the individualised intervention and 28.51 in the group intervention (mean difference, 7.1; 95% CI 2.40 to 11.88; p=0.003).
The personalised intervention led to greater reductions in disability compared to the group intervention at six months (mean difference, 8.65; 95% CI 3.66 to 13.64; p=0.001), and at 12 months (mean difference, 7.02; 95% CI 2.24 to 11.80; p=0.004).
Conclusion(s): The individualised multidimensional intervention resulted in reduced disability at all follow-up points compared to an exercise and education class, however pain was only reduced at post-treatment and not at six or 12 months. These results support the potential for individualised multidimensional interventions to improve disability outcomes for NSCLBP, however additional strategies to maintain improvements in the long-term may be required.
Implications: This individualised intervention may optimise clinical outcomes for people with NSCLBP.
Keywords: low back pain, cognitive functional therapy, group exercise and education
Funding acknowledgements: The first author received a personal PhD scholarship from the Irish Research Council. No other funding was received.
Purpose: To compare a individualised multidimensional intervention (CFT), to group-based exercise and education classes on pain and disability in individuals with NSCLBP.
Methods: Design: A multicentre single blinded randomised controlled trial.
Setting: Two primary care centres and one public hospital in Ireland.
Participants: Individuals aged 18-75 years, with NSCLBP for more than six months, scoring at least 14% on the Oswestry Disability Index (ODI).
Interventions: A physiotherapy-led individualised multidimensional intervention (n=106) where length of intervention varied in a pragmatic manner based on the clinical progression of participants, and six exercise and education classes over a period of six to eight weeks (n=100).
Main outcomes and analysis: Primary outcomes were functional disability (ODI (0=no disability, 100=worst disability) and pain intensity in the past week (0= no pain, 10= worst pain) at post intervention, six months post-randomisation, and 12 months post randomisation. Analysis was by intention to treat, and treatment effects were calculated with linear mixed models.
Results: Of 206 randomised participants (including 152 women; mean age 48.7 years (standard deviation 14.1 years), 130 (63%) completed post-intervention follow-up, 148 (72%) completed six month follow-up, and 142 (69%) completed the 12 month follow-up.
At post-intervention, the mean disability score was 17.33 in the individualised intervention and 25.73 in the class (mean difference, 8.04; 95% confidence interval [CI] 4.43 to 12.73; p 0.001). At six months, the mean disability score was 19.98 in the individualised intervention and 28.65 in the group intervention (mean difference, 8.7; 95% CI 3.76 to 13.59; p=0.001). At 12 months, the mean disability score was 21.37 in the individualised intervention and 28.51 in the group intervention (mean difference, 7.1; 95% CI 2.40 to 11.88; p=0.003).
The personalised intervention led to greater reductions in disability compared to the group intervention at six months (mean difference, 8.65; 95% CI 3.66 to 13.64; p=0.001), and at 12 months (mean difference, 7.02; 95% CI 2.24 to 11.80; p=0.004).
Conclusion(s): The individualised multidimensional intervention resulted in reduced disability at all follow-up points compared to an exercise and education class, however pain was only reduced at post-treatment and not at six or 12 months. These results support the potential for individualised multidimensional interventions to improve disability outcomes for NSCLBP, however additional strategies to maintain improvements in the long-term may be required.
Implications: This individualised intervention may optimise clinical outcomes for people with NSCLBP.
Keywords: low back pain, cognitive functional therapy, group exercise and education
Funding acknowledgements: The first author received a personal PhD scholarship from the Irish Research Council. No other funding was received.
Topic: Musculoskeletal; Pain & pain management; Disability & rehabilitation
Ethics approval required: Yes
Institution: University of Limerick
Ethics committee: Mayo General Hospital Ethics Committee
Ethics number: MGH-14-UL
All authors, affiliations and abstracts have been published as submitted.
