Active exercise, education, and cognitive behavioral therapy for persistent disabling low back pain: a randomized...

Area of Science:

• Primary care research
• Rehabilitation medicine
• Health services research

Background:

• Evidence supports exercise and CBT for low back pain (LBP) in specialist settings.
• Limited evidence exists for primary care delivery of these interventions.
• This study addresses the gap in primary care effectiveness for LBP management.

Purpose of the Study:

• To evaluate a group exercise and education program with a cognitive behavioral therapy (CBT) approach for persistent disabling low back pain (LBP).
• To assess the cost-effectiveness of this primary care-based intervention.
• To investigate the influence of patient preference on treatment outcomes.

Main Methods:

• A randomized controlled trial was conducted in nine UK primary care practices.
• Patients with persistent LBP were randomized to an intervention (group exercise/education with CBT) or control arm.
• Primary outcomes included pain (Visual Analogue Scale) and disability (Roland and Morris Disability Scale) at 12-month follow-up.

Main Results:

• The intervention demonstrated small, nonsignificant reductions in pain and disability.
• The incremental cost-effectiveness ratio was £5000 (approx. $8650) per quality-adjusted life year.
• Patients preferring the intervention experienced clinically important improvements in pain and disability.

Conclusions:

• The primary care-based CBT intervention for LBP yielded modest overall effects.
• Patient preference for treatment significantly impacted outcomes, suggesting a potential role for personalized care.
• Further research into treatment preference is recommended for optimizing LBP management.