Biopsychosocial primary care versus physiotherapy as usual in chronic low back pain: results of a pilot-randomised controlled trial

Abstract

Aim

To compare the effectiveness of a biopsychosocial primary care intervention (Back on Track) with primary care physiotherapy as usual in patients with chronic low back pain (CLBP) experiencing low complex psychosocial complaints.

Method

A double-blind multicentre pilot-randomised controlled trial. Twenty-five patients (≥18 years) with non-specific CLBP (≥12 weeks) experience low psychosocial complaints and a low to moderate level of disability. The Back on Track intervention (four individual and eight group sessions) versus physiotherapy as usual (maximally 12 individual sessions). Primary outcome: functional disability (Quebec Back Pain Disability Score) at post-treatment and 3 months follow-up.

Secondary measures

Anxiety, depression, catastrophizing, pain intensity, kinesiophobia, self-efficacy, global perceived effect. Effects were analysed using linear mixed model analysis.

Results

No significant differences in functional disability were found between interventions at post-treatment (mean difference 0.10, 95% CI: −12.9 to 13.1) and 3 months follow-up (mean difference −5.4, 95% CI −19.1 to 8.3). Secondary outcomes also showed no significant differences.

Conclusions

No differences in effects were found between patients with CLBP experiencing low complex psychosocial complaints who receive the Back on Track intervention compared to patients receiving primary care physiotherapy as usual. Well-powered studies of sufficient methodological quality are needed to detect differences in effects.

Keywords:

• Low back pain
• chronic pain
• cognitive behavioural therapy
• primary health care
• physical therapists
• randomised controlled trial

Acknowledgements

The authors acknowledge Marion de Mooij for her assistance during the study; the Department of Rehabilitation in medicine MUMC + and physicians for the recruitment of patients; Dr. Paul Willems and members of the Spine Centre MUMC + and department of Anaesthesiology for referring patients; Fy’net Collaboration, dr. Frans Abbink (Fysiotherapiepraktijk Abbink), Tom Hameleers (ICL Fysio), Remco Reijnders & Germaine Neumann (Fysiohof), Yvonne Janss (Fysiotherapiepraktijk Yvonne Janss), Rick Kessels (Fysio Zuyd Caberg), Judith Giessen-Ploemen (Fysiotherapiepraktijk Giessen-Ploemen) for providing treatments to patients in the study.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This study was financially supported by the following organizations: Maastricht University; Adelante, Centre of Expertise in Rehabilitation and Audiology Hoensbroek, The Netherlands; Province of Limburg, The Netherlands and CZ Foundation.