Can cognitive behavioural therapy based strategies be integrated into physiotherapy for the prevention of chronic low back pain? A systematic review

Abstract

Purpose: The primary purpose was to detect randomized controlled trials investigating cognitive behaviour therapy-based (CBT) treatments applied in acute/sub-acute low back pain (LBP). The secondary purpose was to analyse the methodological properties of the included studies, and to identify theory-based treatment strategies that are applicable for physiotherapists. Method: A systematic literature search was conducted using four databases. Risk of bias of included studies was assessed and the methodological properties summarized. In addition, content and treatment theory of detected CBT-based strategies were systematically analysed and classified into three distinctive concepts of CBT: operant, cognitive and respondent treatment. Finally, applicability of treatment strategies in physiotherapy practice was discussed. Results: Eight studies were included in the present systematic review. Half of the studies suffered from high risk of bias, and study characteristics varied in all domains of methodology, particularly in terms of treatment design and outcome measures. Graded activity, an operant treatment approach based on principles of operant conditioning, was identified as a CBT-based strategy with traceable theoretical justification that can be applied by physiotherapists. Conclusion: Operant conditioning can be integrated in ambulant physiotherapy practice and is a promising CBT-based strategy for the prevention of chronic LBP.

Implications for Rehabilitation

• Physiotherapist can integrate operant treatment approaches into their standard pain management for acute/sub-acute LBP.

• Graded activity, based on operant conditioning, is a promising treatment approach for the prevention of chronic LBP.

• Health care providers, other than only clinical psychologists, should deliver CBT- based treatment strategies, which aim to decrease pain behaviour by reinforcing exercise behaviour and active coping strategies.

Keywords::

• Biopsychosocial model
• psychosocial intervention
• cognitive behavioural therapy
• physical therapy
• physiotherapy
• lower back pain

Declaration of Interest: The authors report no conflict of interest, and the research project received no funding.