Systematic reviewThe efficacy of targeted interventions for modifiable psychosocial risk factors of persistent nonspecific low back pain – A systematic review
Section snippets
Background
Low back pain (LBP) is common, costly and recurrent. For some people, their LBP becomes persistent and has considerable consequences for their participation in work and social activities (Walker et al., 2004).
Due to diagnostic uncertainties and the high prevalence of false positive pathoanatomic findings, a definitive diagnosis of pain-related pathology cannot be reached for most LBP in primary care and is therefore labelled as non-specific low back pain (NSLBP). Research during the last decade
Types of participants
Participants needed to be experiencing NSLBP, but not pregnant. Studies with more than 15% of participants below the age of 18 years or containing participants aged below 12 years, or containing participants with specific LBP (eg caused by fracture, cancer, inflammatory arthritis) were excluded. Trials containing participants with both LBP and leg pain were included if they had no symptoms or signs of neurocompression (numbness, pins and needles or lower limb muscle weakness) or contained less
Search yield
A flow chart (Fig. 2) documents the selection process of trials included in the review. Four studies met the inclusion criteria (Klaber Moffett et al., 2004; Jellema et al., 2005; Hough et al., 2007; George et al., 2008). All were two-group plus subgroup covariate RCTs and the characteristics of the included studies are shown in Table 1. The reasons for the exclusion of other trials retrieved in full text are noted in Table 2.
Quality assessment
The quality assessment/risk of bias scores for the included studies
Discussion
To the authors’ knowledge, this is the first systematic review investigating the additional effect attributable to targeting psychosocial interventions in people with NSLBP. The four studies included in this review investigated nine hypotheses about targeted psychosocial interventions. Of the 28 subgroup/treatment outcomes tested, only two examples of treatment effect modification were statistically significant (p < 0.05) using the statistical methods employed in this review. These results need
Conclusion
This review identified four studies that investigated the treatment effects of targeted psychosocial interventions for people with non-specific low back pain (NSLBP). Although there were two statistically significant results and some statistical trends, overall these studies provide limited evidence that targeting such psychosocial interventions is effective. Most of the studies were underpowered to appropriately detect treatment effect modification. If it is important to determine if targeting
Authors' contributions
Both authors were involved in the design of the review, analysis and interpretation of data, drafting and revision of the manuscript, and gave final approval of the manuscript.
Competing interests
The manuscript submitted does not contain information about medical devices or drugs. No benefits in any form have been, or will be, received from a commercial party related directly or indirectly to the subject of this manuscript.
Acknowledgement
The authors are grateful to Dr Mark Hancock for comments on a draft manuscript.
References (89)
- et al.
The effectiveness of psychological interventions for the rehabilitation of low back pain: a randomized controlled trial evaluation
Pain
(1992) - et al.
Subgroup analyses in randomized trials: risks of subgroup-specific analyses: power and sample size for the interaction test
Journal of Clinical Epidemiology
(2004) - et al.
The role of an information booklet or oral information about back pain in reducing disability and fear-avoidance beliefs among patients with subacute and chronic low back pain. A randomized controlled trial in a rehabilitation unit
Annales de Readaptation et de Medecine Physique
(2006) - et al.
Catastrophizing moderates the effect of exposure in vivo for back pain patients with pain-related fear
European Journal of Pain
(2010) - et al.
The role of fear-avoidance beliefs in acute low back pain: relationships with current and future disability and work status
Pain
(2001) - et al.
A randomized trial of behavioral physical therapy interventions for acute and sub-acute low back pain
Pain
(2008) - et al.
Depression in chronic back pain patients: prediction of pain intensity and pain disability in cognitive-behavioral treatment
Psychosomatics
(2010) - et al.
Preventing chronic back pain: evaluation of a theory-based cognitive-behavioural training programme for patients with subacute back pain
Patient Education & Counseling
(2006) - et al.
Comparison of physical treatments versus a brief pain-management programme for back pain in primary care: a randomised clinical trial in physiotherapy practice
Lancet
(2005) - et al.
3-year follow-up of a multidisciplinary rehabilitation programme for back and neck pain
Pain
(2005)
Treatment-based subgroups of low back pain: a guide to appraisal of research studies and a summary of current evidence
Best Practice & Research Clinical Rheumatology
Subgroup analysis in obstetrics clinical trials
American Journal of Obstetrics & Gynecology
Exposure in vivo versus operant graded activity in chronic low back pain patients: results of a randomized controlled trial
Pain
TTM-based motivational counselling does not increase physical activity of low back pain patients in a primary care setting: a cluster-randomized controlled trial
Patient Education & Counseling
A randomized controlled trial of exposure in vivo for patients with spinal pain reporting fear of work-related activities
European Journal of Pain
The secondary prevention of low back pain: a controlled study with follow-up
Pain
A randomized trial of a cognitive-behavioral program for enhancing back pain self care in a primary care setting
Pain
Is a videotape to change beliefs and behaviors superior to a standard videotape in acute low back pain? A randomized controlled trial
Spine Journal
The prevention of chronic pain and disability: a preliminary investigation
Behaviour Research & Therapy
Preventing progression to chronicity in first onset, subacute low back pain: an exploratory study
Archives of Physical Medicine and Rehabilitation
Publication and related bias in meta-analysis: power of statistical tests and prevalence in the literature
Journal of Clinical Epidemiology
Efficacy of cognitive therapy for chronic low back pain
Pain
The effects of failure feedback and pain-related fear on pain report, pain tolerance, and pain avoidance in chronic low back pain patients
Pain
Low back pain in Australian adults. Prevalence and associated disability
Journal of Manipulative and Physiological Therapeutics
Clinical outcomes for patients classified by fear-avoidance beliefs and centralization phenomenon
Archives of Physical Medicine and Rehabilitation
New Zealand acute low back pain guide
Multidisciplinary rehabilitation for subacute low back pain: graded activity or workplace intervention or both? A randomized controlled trial
Spine
No clinical effect of back schools in an HMO. A randomized prospective trial
Spine
Minimal clinically important difference. Low back pain: outcome measures
Journal of Rheumatology
Information and advice to patients with back pain can have a positive effect. A randomized controlled trial of a novel educational booklet in primary care
Spine
A clinical prediction rule to identify patients with low back pain most likely to benefit from spinal manipulation: a validation study
Annals of Internal Medicine
Fear of movement/(re)injury in chronic low back pain: education or exposure in vivo as mediator to fear reduction?
Clinical Journal of Pain
A treatment-based classification approach to low back syndrome: Identifying and staging patients for conservative treatment
Physical Therapy
Reduction of pain-related disability in working populations: a randomized intervention study of the effects of an educational booklet addressing psychosocial risk factors and screening workplaces for physical health hazards
Spine
2009 Updated method guidelines for systematic reviews in the Cochrane back review group
Spine
The effect of a fear-avoidance-based physical therapy intervention for patients with acute low back pain: results of a randomized clinical trial
Spine
The effect of a fear-avoidance-based physical Therapy intervention for patients with acute low back pain: results of a randomized controlled trial
Spine
Comparison of graded exercise and graded exposure clinical outcomes for patients with chronic low back pain
Journal of Orthopaedic & Sports Physical Therapy
Effects of education on return-to-work status for people with fear-avoidance beliefs and acute low back pain
Physical Therapy
A guide to interpretation of studies investigating subgroups of responders to physical therapy interventions
Physical Therapy
Independent evaluation of a clinical prediction rule for spinal manipulative therapy: a randomised controlled trial
European Spine Journal
The efficacy of a risk factor-based cognitive behavioral intervention and electromyographic biofeedback in patients with acute sciatic pain. An attempt to prevent chronicity
Spine
Prognostic factors for perceived recovery or functional improvement in non-specific low back pain: secondary analyses of three randomized clinical trials
European Spine Journal
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