Bergstrom C, Jensen I, Hagberg J, et al. Effectiveness of different interventions using a psychosocial subgroup assignment in chronic neck and back pain patients: a 10-year follow-up

Public Health Sciences, Intervention and Implementation Research (IIR), Stockholm, Sweden.
Disability and Rehabilitation (Impact Factor: 1.99). 01/2012; 34(2):110-8. DOI: 10.3109/09638288.2011.607218
Source: PubMed


The aim of this study was to evaluate the potential interaction between treatment content and subgroups according to the Swedish version of the Multidimensional Pain Inventory (MPI-S) on the effect on sickness absence during a 10-year follow-up in a population with chronic neck pain (NP) and/or low back pain (LBP).
This study is based on a randomized controlled multicentre trial with a 10-year follow-up using the MPI-S and included 214 participants. The interventions consisted of Behavioural-oriented Physiotherapy (PT), Cognitive Behavioural Therapy (CBT), Behavioural Medicine Rehabilitation (BM), and a "treatment-as-usual" control group (CG).
There appears to be a difference in the development of sickness absence after rehabilitation for the adaptive coper (AC) group even though the result did not reach statistical significance. AC seems to respond most favourably to the multidisciplinary programme compared to the CG. The development of sickness absence after intervention among interpersonally distressed (ID) and dysfunctional (DYS) patients were similar across all three treatment alternatives as well as CG.
In terms of long-term follow-up of sickness absence, the multidisciplinary programme appears to be most beneficial for DYS and AC patients. In contrast, the CBT and PT interventions failed to benefit any patient group.

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Available from: Irene Botilde Jensen, Dec 05, 2014
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    • "While several high quality studies have explored risk factors for developing chronic neck pain, research on the predictors of treatment outcome is less available. Some studies have found considerable heterogeneity among study populations with pain and it has been suggested that patient pre-treatment characteristics could predict specific subgroups of patients who will benefit most from specific interventions (Bergstr€ om et al., 2012; Gustavsson et al., 2013). "
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    ABSTRACT: This study was conducted to identify possible prognostic factors to predict drop-out and favorable outcome in patients following a multimodal treatment program at an outpatient rehabilitation clinic. A retrospective cohort study was conducted on 437 patients with chronic neck pain involved in an exercise-based rehabilitation program of an outpatient rehabilitation center between January 2008 and November 2011. Prognostic factors were analyzed through a univariate and a multivariate logistic regression analysis. Multivariate logistic regression revealed that a higher age (OR=0.960), presence of headache (OR=0.436) or low back pain (OR=0.525), and having low levels of depression (OR=1.044) increase the odds to complete the multimodal treatment program. A high NDI-score (OR=0.945), a high NRS-score for pain in the upper extremities (OR=0.862), a low NRS score for pain in the neck (OR=1.372), and a trauma in the patient's history (OR=0.411) decrease the odds of having a favorable outcome after the given treatment program. It is important to assess these prognostic factors as they may help therapists to identify patients with a good prognosis or patients at risk. For those at risk, this would allow the treatment approach to be redirected to address their specific needs. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Full-text · Article · Feb 2015 · Manual Therapy
    • "The treatment of back pain must therefore not only focus on medical interventions or physiotherapy but also psychosocial treatments which focus on emotional changes, changes in attitudes, improvement in coping, and activation. There are many studies which show that multimodal treatments, which include psychosocial interventions , can reduce suffering, medication intake, visits to physicians, disability and can improve the long term course [7] [8] [9] [10] [11] [12] [13] [14] [15] [16] [17] [18] [19] [20]. Jäkle and Basler [21] showed in a metaanalysis on prospective, randomized, controlled studies that cognitive behavioral treatment can reduce chronic pain by modification of dysfunctional cognitions . "
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    ABSTRACT: BACKGROUND: It is empirically well documented that psychotherapy is vital in the treatment of chronic back pain. OBJECTIVE: To test in this randomized controlled clinical trial whether cognitive behavior group therapy is effective in respect to pain tolerance and disability apart from the effects on somatization in general and additional to the effects of a multimodal inpatient orthopedic rehabilitation programme. METHODS: Fifty-three patients were randomly assigned to an intervention group, receiving six sessions of "cognitive behavior group therapy for back pain" (CBT-BP), and 50 to a control group who got unspecific occupational therapy sessions instead. Patients were suffering from chronic back pain for at least six months. All patients were treated for 21 days in an orthopedic inpatient rehabilitation unit with a multimodal orthopedic treatment, including active physical therapy, patient education or motivation to exercise. RESULTS: In both groups there is a significant improvement over time in the Symptom Checklist (SCL-90), the Rating of Health Locus of Control Attributions, the Fear Avoidance Beliefs Questionnaire (FABQS) and a Visual Analogue Pain Scale (VAS-pain). There are significant interactions between treatment group and VAS-pain and the FABQS, showing a superior improvement in the intervention group, while no significant superiority is found for the SCL. CONCLUSIONS: The experience of pain can be altered directly and not only through improvement of depression or general somatoform complaints. The study replicates other research and increases the evidence base for this mode of treatment. The treatment effect can be called specific as it is found additional to a multimodal inpatient care programme.
    No preview · Article · Aug 2014 · Journal of Back and Musculoskeletal Rehabilitation
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    • "Similar results were found in another study investigating sick leave, early retirement, and health-related quality of life, where the separate components of a behavioral medicine rehabilitation program were as good as the full combined program.43 When a 10-year follow-up assessment was conducted, the combined program still showed effects on sick leave, while the separate CBT and physiotherapy interventions showed no effect on this outcome.48 "
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    ABSTRACT: The aim of this study is to provide a narrative review of the current state of knowledge of the role of cognitive behavioral therapy (CBT) in the management of chronic nonspecific back pain. A literature search on all studies published up until July 2012 (PubMed and PsycINFO) was performed. The search string consisted of 4 steps: cognitive behavioral therapy/treatment/management/modification/intervention, chronic, back pain (MeSH term) or low back pain (MeSH term), and randomized controlled trial (MeSH term). The conclusions are based on the results from randomized controlled trials (RCTs) and reviews of RCTs. Interventions were not required to be pure CBT interventions, but were required to include both cognitive and behavioral components. The search yielded 108 studies, with 46 included in the analysis. Eligible intervention studies were categorized as CBT compared to wait-list controls/treatment as usual, physical treatments/exercise, information/education, biofeedback, operant behavioral treatment, lumbar spinal fusion surgery, and relaxation training. The results showed that CBT is a beneficial treatment for chronic back pain on a wide range of relevant variables, especially when compared to wait-list controls/treatment as usual. With regards to the other comparison treatments, results were mixed and inconclusive. The results of this review suggest that CBT is a beneficial treatment for chronic nonspecific back pain, leading to improvements in a wide range of relevant cognitive, behavioral and physical variables. This is especially evident when CBT is compared to treatment as usual or wait-list controls, but mixed and inconclusive when compared with various other treatments. Multidisciplinary and transdisciplinary interventions that integrate CBT with other approaches may represent the future direction of management of chronic back pain, with treatments modified for specific circumstances and stakeholders. There is a need for future intervention studies to be specific in their use of cognitive behavioral elements, in order for results to be comparable.
    Full-text · Article · Oct 2012 · Journal of Pain Research
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