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Cognitive functional approach to manage low back pain in male adolescent rowers: A randomised controlled trial

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Abstract

Background Low back pain (LBP) is prevalent among adolescent rowers. This study evaluated the efficacy of a cognitive functional approach to reduce LBP in this population. Methods Thirty-six adolescent male rowers reporting LBP participated. Nineteen were randomly allocated to the intervention group to receive a cognitive functional approach targeting cognitions, movement patterns, conditioning and lifestyle factors relevant to each rower for 8 weeks. The active control group (n=17) received usual care from their coaches (rowing skills and conditioning exercises). The primary outcome of the study was pain intensity as measured by the Numeric Pain Rating Scale during a 15 min ergometer trial preintervention and postintervention. Disability (Patient Specific Functional Scale and Roland Morris Disability Questionnaire) was measured preintervention/postintervention and at 12 weeks follow-up. Isometric muscle endurance of the back extensors and lower limb muscles, usual sitting posture and regional lumbar kinematic data during a 15 min ergometer row were measured preintervention/postintervention. Results Compared with the control group, the intervention group reported significantly less pain during ergometer rowing (Numeric Pain Rating Scale −2.4, p=0.008) and reduced disability (Patient Specific Functional Scale (4.1, p=0.01); Roland Morris Disability Questionnaire (−1.7, p=0.003)) following the intervention, and at 12 weeks follow-up. They also demonstrated greater lower limb muscle endurance (20.9 s, p=0.03) and postured their lower lumbar spine in greater extension during static sitting (−9.6°, p=0.007). No significant differences were reported in back muscle endurance and regional lumbar kinematics during ergometer rowing. Conclusion Cognitive functional approach was more effective than usual care in reducing pain and disability in adolescent male rowers. Clinical Trial Registry Number Australian and New Zealand Clinical Trial Registry Number 12609000565246.
... Disagreement rate between the two authors in the screening process and in the full-text inspection process was 15.5% and 4.2%, respectively. Four studies [19][20][21][22] were eligible. Two studies [19,22] were from the same study project. ...
... However, one study [22] was excluded since the data reported were from the same subjects at a 3-year followup and no additional data were found that were eligible for extraction in the current systematic review. Consequently, three studies [19][20][21] were included the systematic review and assessed for the risk of bias. ...
... The three eligible studies [19][20][21] are summarised in Table 1. All studies were RCTs performed by the same research group. ...
Article
Full-text available
Background To apply the Bio-Psych-Social (BPS) model into clinical practice, it is important not to focus on psychosocial domains only since biomedical factors can also contribute to chronic pain conditions. The cognitive functional therapy (CFT) is the management system based on the BPS model for chronic nonspecific low back pain (CNSLBP). Objectives This study aimed to compare CFT with the other interventions for CNSLBP regarding pain, disability/functional status, QoL and psychological factors. Design This study was a systematic review and meta-analysis of a randomised controlled trial. Method Literature Search was conducted in electronic search engines. Enrolled participants included 1) CNSLBP and 2) primary, secondary, or tertiary care patients. CFT was the interventions included. Comparisons were any types of treatment. Results Three studies met the eligibility criteria. The total number of participants was 336. For pain intensity, MD [95% CIs] was -1.38 [-2.78 − 0.02] and -1.01 [-1.92 − -0.10] at intermediate and long term for two studies, respectively. About disability/functional status, SMD [95% CIs] was -0.76 [-1.46 − -0.07] at the intermediate for three studies and MD [95% CIs] was -8.48 [-11.47 − -5.49] at long term for two studies. About fear of physical activity, MD [95% CIs] was -3.01 [-5.14 − -0.88] and -3.56 [-6.43 − -0.68] at intermediate and long term for two studies, respectively. No studies reported scores associated with QOL. All the quality of the evidence was very low. Conclusions Three studies were included and the quality of all the evidence was very low. Although the study found statistically significant differences in some measures, the effectiveness of the CFT will need to be re-evaluated in the future. Trial registration PROSPERO registration number CRD42020158182 .
... Disagreement rate between the two authors in the screening process and in the full-text inspection process was 15.5% and 4.2%, respectively. Four studies [19][20][21][22] were eligible. Two studies [19,22] were from the same study project. ...
... However, one study [22] was excluded since the data reported were from the same subjects at a 3-year follow-up and no additional data were found that were eligible for extraction in the current systematic review. Consequently, three studies [19][20][21] were included the systematic review and assessed for the risk of bias. ...
... The three eligible studies [19][20][21] are summarised in Table 1. All studies were RCTs performed by the same research group. ...
Preprint
Full-text available
Background To apply the Bio-Psych-Social (BPS) model into clinical practice, it is important not to focus on psychosocial domains only since biomedical factors can also contribute to chronic pain conditions. The cognitive functional therapy (CFT) is the management system based on the BPS model for chronic nonspecific low back pain (CNSLBP). Objectives To compare CFT with the other interventions for CNSLBP regarding pain, disability/functional status, QoL and psychological factors. Design Systematic review and meta-analysis. Method Literature Search was conducted in electronic search engines. Enrolled participants included 1) CNSLBP and 2) primary, secondary, or tertiary care patients. CFT was the interventions included. Comparisons were any types of treatment. Results Three studies met the eligibility criteria. The total number of participants was 336. For pain intensity, MD [95% CIs] was -2.78 [-2.78−0.02] and -1.01 [-1.92−-0.10] at intermediate and long term for two studies, respectively. About disability/functional status, SMD [95% CIs] was -0.76 [-1.46−-0.07] at the intermediate for three studies and MD [95% CIs] was -0.84 [-11.47−-5.49] at long term for two studies. About fear of physical activity, MD [95% CIs] was -3.01 [-5.14−-0.88] and -3.56 [-6.43−-0.68] at intermediate and long term for two studies, respectively. No studies reported scores associated with QOL. All the quality of the evidence was very low. Conclusions Three studies were included and the quality of all the evidence was very low. Although the study found statistically significant differences in some measures, the effectiveness of the CFT will need to be re-evaluated in the future. PROSPERO registration number CRD42020158182
... Disagreement rate between the two authors in the screening process and in the full-text inspection process was 15.5 % and 4.2 %, respectively. Four studies [19][20][21][22] were eligible. Two studies [19,22] were from the same study project. ...
... However, one study [22] was h i g h excluded since the data reported were from the same subjects at a 3-year follow-up and no additional data were found that were eligible for extraction in the current systematic review. Consequently, three studies [19][20][21] were assessed for the risk of bias. ...
... As all studies included in this study [19] were found in the PEDro online database, the scores from the PEDro online database were used. The quality scores of the three eligible studies [19][20][21] are summarized in Table 2. For Ng et al.'s study [20], the sample size was not large, and the participants were somewhat biased toward rowing athletes. ...
Preprint
Full-text available
Background: To apply the Bio-Psych-Social (BPS) model into clinical practice, it is important not to focus on psychosocial domains only since biomedical factors can also contribute to chronic pain conditions. The cognitive functional therapy (CFT) is the management system based on the BPS model for chronic nonspecific low back pain (CNSLBP). Objectives: To compare CFT with the other interventions for CNSLBP regarding pain, disability/functional status, QoL and psychological factors. Design: Systematic review and meta-analysis. Method: Literature Search was conducted in electronic search engines. Enrolled participants included 1) CNSLBP and 2) primary, secondary, or tertiary care patients. CFT was the interventions included. Comparisons were any types of treatment. Results: Three studies met the eligibility criteria. The total number of participants was 336. For pain intensity, MD [95% CIs] was -2.78 [-2.78−0.02] and -1.01 [-1.92−-0.10] at intermediate and long term for two studies, respectively. About disability/functional status, SMD [95% CIs] was -0.76 [-1.46−-0.07] at the intermediate for three studies and MD [95% CIs] was -0.84 [-11.47−-5.49] at long term for two studies. About fear of physical activity, MD [95% CIs] was -3.01 [-5.14−-0.88] and -3.56 [-6.43−-0.68] at intermediate and long term for two studies, respectively. No studies reported scores associated with QOL. All the quality of the evidence was very low. Conclusions: Three studies were included and the quality of all the evidence was very low. Although the study found statistically significant differences in some measures, the effectiveness of the CFT will need to be re-evaluated in the future. PROSPERO registration number CRD42020158182
... 27 There is a lack of research examining specific exercise interventions in adult rowers, although targeting trunk and leg strength and endurance as part of a cognitive functional approach in adolescent rowers was associated with clinical improvement in LBP. 28 Person-centred care involving a multidimensional approach that also includes trunk conditioning is appropriate 29 but further research is needed to determine specific modalities. Furthermore, some of the rowers reported being advised by coaches and/or the medical team that corestrengthening exercises were necessary for protection of the spine and others described unhelpful behaviours in relation to everyday activities such as bending and sitting with a straight back. ...
Article
Objective Low back pain (LBP) is highly prevalent in rowing and can be associated with significant disability and premature retirement. A previous qualitative study in rowers revealed a culture of concealment of pain and injury due to fear of judgement by coaches or teammates. The aim of this study was to explore rowers' perspectives in relation to diagnosis, contributory factors, and management of LBP. Design Qualitative secondary analysis. Methods We conducted a secondary analysis of interview data previously collected from 25 rowers (12 in Australia and 13 in Ireland). A reflexive thematic analysis approach was used. Results We identified three themes: 1) Rowers attribute LBP to structural/physical factors. Most rowers referred to structural pathologies or physical impairments when asked about their LBP diagnosis. Some participants were reassured if imaging results helped to explain their LBP, but others were frustrated if findings on imaging did not correlate with their symptoms. 2) Rowing is viewed as a risky sport for LBP. Risk factors proposed by the rowers to contribute to LBP were primarily physical and included ergometer training, individual technique, and repetitive loading. 3) Rowers focus on physical strategies for the management and prevention of their LBP. In particular, rowers considered stretching and core-strengthening exercise to be important components of treatment. Conclusion Rowers' understanding of the cause and management of LBP was predominantly biomedical and focused on physical impairments. Further education of rowers, coaches and healthcare professionals in relation to the contribution of psychosocial factors may be helpful for rowers experiencing LBP.
... [27] A randomized controlled trial conducted in male rowers with LBP showed that cognitive functional approach significantly reduced pain and disability. [28] A pilot study evaluated clinical outcomes and pain thresholds after a 12week cognitive functional therapy compared to multidisciplinary pain management pathway in patients with severe chronic LBP. It showed that CFT group helped to reduced disability and improved quality of life at 3 and 6 months. ...
... 46 47 Similar findings have been identified in other sporting populations with LBP. 48 It has been shown that positioning of the lumbar spine closer to the end of range was associated with pain in gymnastics, cycling, golf and rowing, [49][50][51][52] and altering the position of the lumbar spine to be further from the end of range was associated with pain relief. 52 53 In addition to these kinematic differences, high effect sizes were discovered demonstrating greater tibial acceleration along the z-axis at BFI in individuals with no history of LBP as well as greater time to peak resultant tibial acceleration in the no history of LBP group at FFI. ...
Article
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Objectives To investigate spinal kinematics, tibial and sacral impacts during fast bowling, among bowlers with a history of low back pain (LBP) (retrospective) and bowlers who developed LBP in the follow-up season (prospective). Methods 35 elite male fast bowlers; senior (n=14; age=24.1±4.3 years; height=1.89±0.05 m; weight=89.2±4.6 kg) and junior (n=21; age=16.9±0.7; height=1.81±0.05; weight=73.0±9.2 kg) were recruited from professional county cricket clubs. LBP history was gathered by questionnaire and development of LBP was monitored for the follow-up season. Spinal kinematics, tibial and sacral impacts were captured using inertial measurement units placed over S1, L1, T1 and anteromedial tibia. Bonferroni corrected pairwise comparisons and effect sizes were calculated to investigate differences in retrospective and prospective LBP groups. Results Approximately 38% of juniors (n=8) and 57% of seniors (n=8) reported a history of LBP. No differences were evident in spinal kinematics or impacts between those with LBP history and those without for seniors and juniors. Large effect sizes suggest greater rotation during wind-up (d=1.3) and faster time-to-peak tibial impacts (d=1.5) in those with no history of LBP. One junior (5%) and four (29%) seniors developed LBP. No differences were evident in spinal kinematics or impacts between those who developed LBP and those who did not for seniors. In seniors, those who developed LBP had lower tibial impacts (d=1.3) and greater lumbar extension (d=1.9) during delivery. Conclusion Retrospective analysis displayed non-significant differences in kinematics and impacts. It is unclear if these are adaptive or impairments. Prospective analysis demonstrated large effect sizes for lumbar extension during bowling suggesting a target for future coaching interventions.
Article
Background Patients’ beliefs have an important influence on the clinical management of low back pain and healthcare professionals should be prepared to address these beliefs. There is still a gap in the literature about the influence of patients’ perceptions of their clinical diagnosis on the severity of their pain experience and disability. Objectives To identify the perceptions of patients with chronic non-specific low back pain regarding the influence of their clinical diagnosis on pain, beliefs, and daily life activities. Methods Qualitative study of 70 individuals with chronic non-specific low back pain. A semi structured interview was conducted about patients’ beliefs and perceptions regarding the influence of clinical diagnosis on their daily activities and pain intensity. Results Most participants believed that higher number of different clinical diagnoses for the same individual may be associated with high pain intensity and disability for daily activities and that pain and injury are directly related. Patients beliefs were grouped into four main themes: (1) pain has multifactorial explanation in physical dimension; (2) improvement expectation is extremely low in patients with chronic pain; (3) clinical diagnosis influences pain and disability levels; (4) clinical diagnosis is extremely valued by patients. Conclusions Patients believe that there is a strong relationship between structural changes in the lower back, pain, and daily life activities; thus, evidencing a strong influence of the biomedical model on their beliefs.
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Sportler leiden häufig unter lumbalen Rückenschmerzen. Die Ursachen dafür bleiben oft unklar und auch der Umgang mit den Beschwerden ist nicht einfach – erst recht nicht, wenn aufgrund der Schmerzen die sportliche Laufbahn auf der Kippe steht. Da ist guter Rat teuer.
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Objective: Persistent low back pain (PLBP) is a common and costly health problem worldwide. Better strategies to manage it are required. The purpose of this study was to longitudinally evaluate absenteeism, pain, and disability in nurses with PLBP following a cognitive functional therapy (CFT) intervention. Methods: In this case-series pilot study, 33 eligible nurses with PLBP were recruited. During the baseline phase A (no intervention) outcome measures were collected on 2 occasions 6 months apart (A1 and A2). During phase B, subjects participated in an individualized CFT intervention for 14 weeks. During phase C (no intervention), outcomes were measured immediately after the intervention, as well as 3, 6, 9, 12 and 36 months after the intervention (secondary outcomes only until 12 months). LBP-related work absenteeism, pain intensity (Numeric Rating Scale) and disability (Oswestry Disability Index) were the primary outcomes. Health care seeking, a range of psychological and lifestyle variables, and global perceived effect were secondary outcomes. Results: Days of absenteeism due to LBP were significantly reduced in the first and second calendar year after the CFT intervention, but not the third and fourth. Disability was significantly reduced immediately after (-4.4; 95%CI = -6.5 to -2.2) and at 3 months (-4.3; 95%CI = -6.6 to -2.0), 9 months (-6.0; 95%CI = -8.1 to -3.9), and 12 months (-4.9; 95%CI = -7.0 to -2.8) after the intervention. Pain was significantly reduced immediately after (-1.2; 95%CI = -1.7 to -0.8) and at 3 months (-1.5; 95%CI = -2.0 to -0.9), 9 months (-1.1; 95%CI = -1.9 to -0.3) and 12 months (-0.9; 95%CI = -1.5 to -0.2) after the intervention. Total health care seeking (consults and proportion of participants) was significantly reduced after the intervention. All psychosocial variables, except for 1, demonstrated significant improvements at all follow-ups. Conclusions: This case-series pilot study demonstrated significant reductions in LBP-related absenteeism, pain intensity, disability, health care seeking, and several psychological and lifestyle behaviors until 1 year follow-up among nurses with PLBP following an individualized CFT intervention. Further evaluation of the efficacy.
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The primary objective of this study was to determine the lifetime and point prevalence of low back pain, the related pain intensity and the rowing-related aggravating factors for low back pain in adolescent rowers who participated in school-level competitions. The secondary objective was to determine whether between-gender differences existed in these data. Retrospective cross-sectional survey METHOD: 130 adolescent male and 235 adolescent female rowers aged between 14 and 16 years were recruited in this study. Participants completed a questionnaire to determine their lifetime and point prevalence of low back pain, their pain intensity and rowing-related factors that aggravated their low back pain. A high lifetime and point prevalence of low back pain were found in both adolescent male (93.8% and 64.6%, respectively) and female (77.9% and 52.8%, respectively) rowers. A significant between-gender difference was reported for both statistics (p<0.001). A significantly lower (p=0.003) level of pain intensity via a visual analog scale was found for males (4.1/10) when compared to females (5.0/10). Similar rowing-related aggravating factors were reported by males and females although fewer males reported that lifting the rowing shell aggravated their low back pain. A high lifetime and point prevalence of low back pain was reported by the adolescent rowers recruited in this study. While a greater proportion of adolescent male rowers reported low back pain, they reported a lower intensity of pain when compared to their female counterparts. Coaches, clinicians and rowers should be made aware of these findings such that future research and development can focus on promoting pain management strategies in this sport.